Provider Demographics
NPI:1851152532
Name:SAN, SOE (FNP-C)
Entity type:Individual
Prefix:
First Name:SOE
Middle Name:
Last Name:SAN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1738 HOBSON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4882
Mailing Address - Country:US
Mailing Address - Phone:260-418-2909
Mailing Address - Fax:
Practice Address - Street 1:710 W DEWEY ST
Practice Address - Street 2:BREMEN, IN
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46226-1466
Practice Address - Country:US
Practice Address - Phone:574-301-4351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-19
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF11230599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily