Provider Demographics
NPI:1710315783
Name:GONZAGOWSKI-SATTER, LAURIE LYNETTE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:LYNETTE
Last Name:GONZAGOWSKI-SATTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-3201
Mailing Address - Country:US
Mailing Address - Phone:260-426-3250
Mailing Address - Fax:
Practice Address - Street 1:413 E JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-3201
Practice Address - Country:US
Practice Address - Phone:260-426-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28148056A163W00000X
IN71002017A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse