MEDICARE: MRS. BAILEY NICOLE TRESENRITER PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10001404A	IN

General Provider Information

NPI Number	:	1407101645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BAILEY NICOLE TRESENRITER PA-C

Provider Business Mailing Address
First Line	:	22818 OLD US 20
Second Line	:
City	:	ELKHART
State	:	IN
Zip	:	46516-9150
Country	:	US
Telephone Number	:	574-389-1231
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 WAYNE ST
Second Line	:
City	:	MIDDLEBURY
State	:	IN
Zip	:	46540-9074
Country	:	US
Telephone Number	:	574-389-1231
Fax Number	:	574-389-1232

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2012
Last Update Date	:	02/27/2014

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Directions to “ MRS. BAILEY NICOLE TRESENRITER PA-C” Practice Location

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