Healthcare Provider Details

I. General information

NPI: 1326456302
Provider Name (Legal Business Name): LAURA K SILVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N SAWYER RD
KENDALLVILLE IN
46755-2572
US

IV. Provider business mailing address

11109 PARKVIEW PLAZA DR # 117
FORT WAYNE IN
46845-1701
US

V. Phone/Fax

Practice location:
  • Phone: 260-425-6390
  • Fax: 260-425-6395
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71004993A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: