Provider Demographics
NPI:1942290663
Name:DRIVER, NORMA J (NP)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:J
Last Name:DRIVER
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:1818 CAREW ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4788
Mailing Address - Country:US
Mailing Address - Phone:260-482-8241
Mailing Address - Fax:260-373-4144
Practice Address - Street 1:1818 CAREW ST
Practice Address - Street 2:SUITE 230
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4788
Practice Address - Country:US
Practice Address - Phone:260-482-8241
Practice Address - Fax:260-373-4144
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28036680363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP18812Medicare UPIN
IN162850MMedicare ID - Type Unspecified