Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AG02210087 | IN |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 71011403A | IN |
NPI | 1073184206 |
---|---|
Provider Name | Josephine Chapita |
First Address | Fort Wayne, IN 46851-0299 |
Second Address | Crown Point, IN 46307-1877 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 27/10/2021 |