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General NPI Number Information
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NPI Number | 1841216363
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Entity Type | Individual
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Provider Name | PATRICIA M NIETCH NP
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Gender | Female
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 215 W 4TH ST
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City | MISHAWAKA
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State | IN
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Zip | 46544-1917
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Country | US
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Telephone | 574-239-5277
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Fax |
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Provider Business Mailing Address
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Address Line | 801 E LASALLE AVE
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City | SOUTH BEND
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State | IN
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Zip | 46617-2814
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Country | US
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Telephone | 574-239-5277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71000636A
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License Number State | IN
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