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NPI 1750111084 · on the registry since 2024
Practice
- Address
- 513 S 25th St
South Bend, IN 46615 - Phone
- (574) 341-0353
Additional practice sites
- 1010 N Bendix Dr, South Bend, IN
Registry record
- Primary taxonomy
- 1041C0700X
1041C0700X
- Licence states on file
- IN
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2026-05-15
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Indiana