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General NPI Number Information
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NPI Number | 1225605207
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Entity Type | Organization
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Legal Business Name | NURSE PRACTITIONER SERVICES OF MICHIANA
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Dates
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Enumeration Date | 06/08/2021
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 5230 BECK DR STE 3
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City | ELKHART
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State | IN
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Zip | 46516-9059
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Country | US
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Telephone | 574-622-1522
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Fax | 574-699-1588
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Provider Business Mailing Address
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Address Line | 5230 BECK DR STE 3
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City | ELKHART
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State | IN
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Zip | 46516-9059
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Country | US
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Telephone | 574-622-1522
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Fax | 833-310-2090
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Authorized Official
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Title or Position | OWNER
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Name | KERTES STEPHANIE
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Credential | NP
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Telephone | 574-274-3925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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