Healthcare Provider Details

I. General information

NPI: 1235959404
Provider Name (Legal Business Name): NICOLE NEIBEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S LANDMARK AVE
BLOOMINGTON IN
47403-3239
US

IV. Provider business mailing address

739 QUARTERHORSE RUN
BARGERSVILLE IN
46106-8750
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-3333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71015902A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28252445C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: