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General NPI Number Information
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NPI Number | 1396463956
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Entity Type | Individual
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Provider Name | DIANE NICOLE GUTGSELL PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/19/2022
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 1717 S CALHOUN ST
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City | FORT WAYNE
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State | IN
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Zip | 46802-5257
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Country | US
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Telephone | 260-458-2641
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Fax |
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Provider Business Mailing Address
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Address Line | 12853 SLASH PASS
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City | FORT WAYNE
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State | IN
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Zip | 46818-0062
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Country | US
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Telephone | 812-881-1741
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5302414434
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 26030090A
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License Number State | IN
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