Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71005551A | IN |
NPI | 1003295833 |
---|---|
Provider Name | Grace E. Sneary |
First Address | Fort Wayne, IN 46804-7934 |
Second Address | New Haven, IN 46774-2052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2015 |
Last Update Date | 08/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201311220 | (05) | IN |