Healthcare Provider Details

I. General information

NPI: 1891043212
Provider Name (Legal Business Name): GLENDA ENSWEILER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LAKE AVE STE 106
PLYMOUTH IN
46563-7830
US

IV. Provider business mailing address

5215 HOLY CROSS PKWY
MISHAWAKA IN
46545-1469
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-5220
  • Fax: 574-335-0859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5651
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006868A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN-039913
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: