Healthcare Provider Details

I. General information

NPI: 1619447976
Provider Name (Legal Business Name): PRATIMA DHAKAL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 N EDDY ST STE 200
SOUTH BEND IN
46617-1478
US

IV. Provider business mailing address

1251 N EDDY ST STE 200
SOUTH BEND IN
46617-1478
US

V. Phone/Fax

Practice location:
  • Phone: 833-387-7440
  • Fax: 773-645-0730
Mailing address:
  • Phone: 833-387-7440
  • Fax: 773-645-0730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008551B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008551A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: