Healthcare Provider Details

I. General information

NPI: 1336695782
Provider Name (Legal Business Name): NADINE RENE' HANDY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NADINE RENE' CLARK

II. Dates (important events)

Enumeration Date: 08/26/2016
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3978 NEW VISION DR.
FORT WAYNE IN
46825
US

IV. Provider business mailing address

6586 N 300 E
LEESBURG IN
46538
US

V. Phone/Fax

Practice location:
  • Phone: 260-672-4680
  • Fax:
Mailing address:
  • Phone: 574-518-1904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number71006351A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: