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Individual

NANCY JANE PAUNICKA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
RN MS-FNP-CS

Contact information

Practice address
3777 NORTH FRONTAGE ROAD, MICHIGAN CITY, IN 46360-7694
(219) 877-3880
(219) 879-6365
Mailing address
PO BOX 1690, LA PORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71000141A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000772332
ANTHEM BCBS
IN
05
200083140
IN
01
M400075623
MEDICARE PTAN
IN
Enumeration date
09/30/2005
Last updated
11/28/2012
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