Healthcare Provider Details

I. General information

NPI: 1548066491
Provider Name (Legal Business Name): FEMME MED & SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 W JEFFERSON BLVD
FORT WAYNE IN
46804-6803
US

IV. Provider business mailing address

3144 BREYERTON CV
FORT WAYNE IN
46814-0002
US

V. Phone/Fax

Practice location:
  • Phone: 260-252-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY SCOTT
Title or Position: OWNER/MD
Credential: MD
Phone: 219-263-9340