Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71001089A | IN |
NPI | 1013157809 |
---|---|
Provider Name | Teresa Marie Dobrzykowski |
First Address | South Bend, IN 46635-1781 |
Second Address | Mishawaka, IN 46545-9034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2009 |
Last Update Date | 06/03/2009 |