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NPI Code Detail

MEDICARE: MS. NICOLE MARIE HELSOM P.A.

MEDICARE: MS. NICOLE MARIE HELSOM P.A.
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
1363A00000XPhysician Assistant10000849AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00311647OTHERMEDICARE RAILROAD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000386480OTHERBCBS

General Provider Information

NPI Number : 1790883502
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICOLE MARIE HELSOM P.A.
Provider Business Mailing Address
First Line : 5750 FALLS DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7147
Country : US
Telephone Number : 260-436-8000
Fax Number : 260-432-5587
Provider Business Practice Location Address
First Line : 5750 FALLS DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7147
Country : US
Telephone Number : 260-436-8000
Fax Number : 260-432-5587
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 11/06/2007

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