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General NPI Number Information
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NPI Number | 1871014589
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Entity Type | Individual
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Provider Name | MINDY HARRIS FNP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2017
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 11143 PARKVIEW PLAZA DR
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City | FORT WAYNE
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State | IN
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Zip | 46845-1727
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Country | US
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Telephone | 260-425-6330
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Fax |
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Provider Business Mailing Address
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Address Line | 15133 LIONS PSGE
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City | LEO
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State | IN
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Zip | 46765-9597
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Country | US
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Telephone | 260-341-2397
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71007377A
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License Number State | IN
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