Healthcare Provider Details

I. General information

NPI: 1194203851
Provider Name (Legal Business Name): LAURA MARIE FESSLER MSN, CCRN, AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2018
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N MICHIGAN ST STE 400
SOUTH BEND IN
46601-1081
US

IV. Provider business mailing address

3245 HEALTH DR STE 100
GRANGER IN
46530-1380
US

V. Phone/Fax

Practice location:
  • Phone: 574-647-8120
  • Fax: 574-647-8111
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71016976A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: