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General NPI Number Information
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NPI Number | 1154312122
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Entity Type | Individual
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Provider Name | DUANE M WAMPLER PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 7881 CARNEGIE BLVD
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City | FORT WAYNE
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State | IN
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Zip | 46804-5792
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Country | US
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Telephone | 260-436-8000
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Fax | 260-436-0929
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Provider Business Mailing Address
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Address Line | 1802 DAY RD
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City | MISHAWAKA
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State | IN
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Zip | 46545-4329
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Country | US
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Telephone | 574-204-7200
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Fax | 574-252-0633
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10000266A
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License Number State | IN
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