Healthcare Provider Details

I. General information

NPI: 1700700481
Provider Name (Legal Business Name): ELIZABETH KIBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 W 4TH ST
MISHAWAKA IN
46544-1948
US

IV. Provider business mailing address

420 W 4TH ST
MISHAWAKA IN
46544-1948
US

V. Phone/Fax

Practice location:
  • Phone: 574-307-7673
  • Fax: 574-307-7692
Mailing address:
  • Phone: 574-307-7673
  • Fax: 574-307-7692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71018480A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: