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Individual

PATRICIA M NIETCH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
215 W 4TH ST, MISHAWAKA, IN 46544-1917
(574) 239-5277
Mailing address
801 E LASALLE AVE, SOUTH BEND, IN 46617-2814
(574) 239-5277

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000636A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200292400
IN
Enumeration date
07/15/2006
Last updated
07/09/2007
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