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General NPI Number Information
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NPI Number | 1013242080
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Entity Type | Individual
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Provider Name | LENSA GIDEON GIRSHA BSN, MS, APN
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Gender | Female
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 06/04/2020
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Provider Practice Location Address
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Address Line | 417 S WHITLOCK ST
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City | BREMEN
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State | IN
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Zip | 46506-1626
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Country | US
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Telephone | 574-546-3730
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Fax |
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Provider Business Mailing Address
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Address Line | 707 E CEDAR ST STE 200
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City | SOUTH BEND
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State | IN
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Zip | 46617-2057
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Country | US
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Telephone | 574-335-8707
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Fax | 574-335-0750
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 28163955A
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License Number State | IN
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