Provider Demographics
NPI:1013242080
Name:GIRSHA, LENSA GIDEON (BSN, MS, APN)
Entity Type:Individual
Prefix:MRS
First Name:LENSA
Middle Name:GIDEON
Last Name:GIRSHA
Suffix:
Gender:F
Credentials:BSN, MS, APN
Other - Prefix:
Other - First Name:LENSA
Other - Middle Name:GIDEON
Other - Last Name:GIRSHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN, MS, APN
Mailing Address - Street 1:707 E CEDAR ST
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8707
Mailing Address - Fax:574-335-0750
Practice Address - Street 1:417 S WHITLOCK ST
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1626
Practice Address - Country:US
Practice Address - Phone:574-546-3730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28163955A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201253250Medicaid
IN000000912794OtherBCBS IMA
IN201253250Medicaid