MEDICARE: HNIN NWAY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	71016166A	IN
2	163W00000X	Registered Nurse	28231273A	IN

General Provider Information

NPI Number	:	1528883279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HNIN NWAY NP

Provider Business Mailing Address
First Line	:	4118 NANTUCKET DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5623
Country	:	US
Telephone Number	:	260-312-6202
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 W WASHINGTON CENTER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-1526
Country	:	US
Telephone Number	:	317-660-8503
Fax Number	:	260-233-7905

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2024
Last Update Date	:	01/28/2025

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