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NPI Code Detail

MEDICARE: VICKI L BAHLS NP

MEDICARE: VICKI L BAHLS NP
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
1163W00000XRegistered Nurse28058063AIN
2363L00000XNurse Practitioner71000085IN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1500020063OTHERINRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619962198
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICKI L BAHLS NP
Provider Business Mailing Address
First Line : 2518 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1675
Country : US
Telephone Number : 260-432-4400
Fax Number : 260-969-6898
Provider Business Practice Location Address
First Line : 2518 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-1675
Country : US
Telephone Number : 260-432-4400
Fax Number : 260-969-6898
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 03/05/2014

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