Most Relevant Information
Provider Data
| NPI Number: | 1003328592 |
| Provider Name: | MCKENNA A GOTTFRIED |
| Entity Type: | Individual |
| Taxonomy Code: | 163W00000X |
| Specialty: | Registered Nurse |
| License Number: | 28194377A |
Most Important Dates
| Enumeration Date: | 10/25/2017 |
| Last Updated: | 07/30/2024 |
Provider Practice Location
3909 NEW VISION DR
FORT WAYNE
IN
468451725
Practice Location Phone/Fax
| Phone: | 2604255500 |
| Fax: | 2604255525 |
Provider Mailing Location
11109 PARKVIEW PLAZA DR # 117
FORT WAYNE
IN
468451701
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |