Individual provider · Type 1 NPI

Jaclyn Ann Fusco

Pediatric Nurse Practitioner · South Bend, IN

NPI number 1063113355 Active

Practice location

100 Navarre Pl Ste 5550
South Bend, IN 46601-1169

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Specialties and licenses

TaxonomyCodeLicense
Registered Nurse 163W00000X28265298A (IN)
Pediatric Nurse Practitioner Primary 363LP0200X202325197 (IN)

Pediatric Nurse Practitioner: Definition to come...

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About NPI 1063113355

Jaclyn Ann Fusco's National Provider Identifier is 1063113355, issued on Mar 14, 2023. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in South Bend, IN. The record was last updated on Apr 2, 2024.