Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 28053571A | IN |
NPI | 1063522282 |
---|---|
Provider Name | Ms. Ludmila Roebel |
First Address | Fort Wayne, IN 46815-8566 |
Second Address | Fort Wayne, IN 46802-5257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |