Healthcare Provider Details

I. General information

NPI: 1659654929
Provider Name (Legal Business Name): MICHAELA B NUFER NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHAELA A. BRINES RN

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD WEST WING
ELKHART IN
46514-2483
US

IV. Provider business mailing address

600 EAST BLVD
ELKHART IN
46514-2483
US

V. Phone/Fax

Practice location:
  • Phone: 574-523-2751
  • Fax: 574-389-4840
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number28068582A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WN0003X
TaxonomyLow-Risk Neonatal Registered Nurse
License Number28068582A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number71003932A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: