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NPI Code Detail

MEDICARE: PATRICIA M NIETCH NP

MEDICARE: PATRICIA M NIETCH NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner71000636AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841216363
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA M NIETCH NP
Provider Business Mailing Address
First Line : 801 E LASALLE AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-2814
Country : US
Telephone Number : 574-239-5277
Fax Number :
Provider Business Practice Location Address
First Line : 215 W 4TH ST
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-1917
Country : US
Telephone Number : 574-239-5277
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/15/2006
Last Update Date : 07/09/2007

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Directions to “ PATRICIA M NIETCH NP” Practice Location

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