Fusco, Jaclyn Ann

Fusco, Jaclyn Ann is an individual health care provider with primary practice located at 100 Navarre Pl Ste 5550 , South Bend IN 46601-1169. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is her primary health care specialty. Fusco, Jaclyn Ann can be contacted via phone (574) 647-2550.

Contact Information

Primary practice address
100 Navarre Pl Ste 5550 South Bend IN 46601-1169
Phone: (574) 647-2550
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 28265298A Indiana
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X 202325197 Indiana

Profile Details

NPI number 1063113355
LBN Legal business name Fusco, Jaclyn Ann
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 14th, 2023
Last updated Apr 2nd, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1063113355 NPPES
Indiana MEDICAID 300078118

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