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General NPI Number Information
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NPI Number | 1952913279
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Entity Type | Individual
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Provider Name | JOSHUA DANIEL AVERY FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 420 W 4TH ST
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City | MISHAWAKA
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State | IN
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Zip | 46544-1948
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Country | US
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Telephone | 574-307-7673
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Fax |
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Provider Business Mailing Address
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Address Line | 30613 OAKBROOK DR
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City | GRANGER
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State | IN
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Zip | 46530-5054
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Country | US
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Telephone | 260-336-2155
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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 | 28213722A
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License Number State | IN
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