Provider Demographics
NPI:1154656130
Name:GARBER, EMILY ANNE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:GARBER
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:WRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CNP
Mailing Address - Street 1:1852 ASHBURN DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-6537
Mailing Address - Country:US
Mailing Address - Phone:574-533-5808
Mailing Address - Fax:574-534-7215
Practice Address - Street 1:1852 ASHBURN DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-6537
Practice Address - Country:US
Practice Address - Phone:574-533-5808
Practice Address - Fax:574-534-7215
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005237A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200973390Medicaid