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General NPI Number Information
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NPI Number | 1366386799
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE PSYCHIATRIC SERVICES LLC
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 14903 SANDSTONE DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-8888
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Country | US
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Telephone | 260-249-0409
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Fax |
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Provider Business Mailing Address
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Address Line | 429 E DUPONT RD # 1064
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City | FORT WAYNE
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State | IN
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Zip | 46825-2051
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Country | US
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Telephone | 260-249-0409
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | CHRISTINA E AGUNANNE
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Credential | DNP
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Telephone | 260-249-0409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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