MEDICARE: JEREMY JAMES GERMAINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	28214495A	IN

General Provider Information

NPI Number	:	1659057552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY JAMES GERMAINE

Provider Business Mailing Address
First Line	:	6135 N HAMPTON PLACE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815
Country	:	US
Telephone Number	:	765-667-3656
Fax Number	:

Provider Business Practice Location Address
First Line	:	6135 N HAMPTON PLACE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815
Country	:	US
Telephone Number	:	765-667-3656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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