Individual ProviderAndrea PlaceNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address7916 W Jefferson Blvd, Fort Wayne, IN 46804-4140(260) 434-6412(260) 434-6403PECOS EnrollmentBased on the most recent information from CMS, provider Andrea Place is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1467024455Provider TypeIndividualFull NamePlace, AndreaCredentialFNP-CGenderFemaleSole ProprietorNoEnumeration Date7/11/2021Last Updated7/20/2022Contact InformationPractice LocationPractice Address7916 W Jefferson Blvd, Fort Wayne, IN 46804-4140Phone(260) 434-6412Fax(260) 434-6395Mailing LocationMailing Address6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934Phone(260) 434-6403Fax(260) 434-6395Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71011572IndianaCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicense28229563AIndianaCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28229563AIndiana