Individual
NICKIE RALSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN FNP
Contact information
Practice address
1855 S MAIN ST, STE A, GOSHEN, IN 46526-4852
(574) 533-7476
(574) 533-7145
Mailing address
1855 S MAIN ST, STE A, GOSHEN, IN 46526-4852
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005206A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201269510
—
IN
Enumeration date
10/03/2014
Last updated
05/03/2023
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