Provider Demographics
NPI:1336695782
Name:HANDY, NADINE RENE' (FNP)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:RENE'
Last Name:HANDY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:RENE'
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6586 N 300 E
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46538
Mailing Address - Country:US
Mailing Address - Phone:574-518-1904
Mailing Address - Fax:
Practice Address - Street 1:3978 NEW VISION DR.
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825
Practice Address - Country:US
Practice Address - Phone:260-672-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006351A363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health