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Individual

MRS. JOYCE ELLEN RACZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, FNP-C, RN

Contact information

Practice address
621 MEMORIAL DR STE 402, SOUTH BEND, IN 46601-1074
(574) 647-2500
(574) 647-7170
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28082633A
IN
363L00000X
Nurse Practitioner
Primary
71005543
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000955116
BCBS CENTENNIAL NEIGHBORHOOD HEALTH CENTER
IN
05
201315860
IN
Enumeration date
05/05/2015
Last updated
03/28/2016
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