JENNIFER DIANE MATA

FORT WAYNE, IN
NPI1922747294
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy363L00000X Nurse Practitioner
(Licence: IN  71014672A)
Additional Taxonomies363LF0000X Nurse Practitioner, Family
(Licence: IN  71014672A)
Enumeration Date2022-06-03
Last Update Date2024-05-17
Business Address
JENNIFER DIANE MATA
2121 LAKE AVE
FORT WAYNE, IN 46805-5100
Phone number: 260-426-5431
Mailing Address
JENNIFER DIANE MATA
2121 LAKE AVE
FORT WAYNE, IN 46805-5100
Phone number: