Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 01050882 | IN |
N | 207QA0401X | Family Doctor - Addiction Medicine | 01050882 | IN |
NPI | 1326047721 |
---|---|
Provider Name | Lynn Van Valer Faur |
First Address | Fort Wayne, IN 46815-8424 |
Second Address | Fort Wayne, IN 46815-8424 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2005 |
Last Update Date | 20/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200284730 | (05) | IN |
H15160 | (02) |