Healthcare Provider Details

I. General information

NPI: 1255819405
Provider Name (Legal Business Name): NICHOLE MARIE PATTEN DNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE MARIE PATTEN DNP, FNP-BC

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S LAKE PARK AVE
HOBART IN
46342-6638
US

IV. Provider business mailing address

2214 COLDSPRING RD
CROWN POINT IN
46307-9335
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6200
  • Fax:
Mailing address:
  • Phone: 219-331-6677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28211762A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008400A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: