Healthcare Provider Details

I. General information

NPI: 1679710487
Provider Name (Legal Business Name): PATRICIA ELENA BAIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MAIN ST
MUNSTER IN
46321-4066
US

IV. Provider business mailing address

801 MAIN ST
MUNSTER IN
46321-4066
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008072
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002800A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: