Doctor Name: | NICKIE RALSTON |
NPI Number: | 1013310184 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSN FNP |
License Number: | 71005206A |
Business Practice Address: | 1855 S Main St Ste A Goshen, IN - 465264852 |
Business Phone Number: | 5745337476 |
Business Fax Number: | 5745337145 |
Mailing Address: | 1855 S Main St, Ste A GOSHEN |
State: | IN |
Postal Code: | 465264852 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/03/2014 |
NPI Last Update Date: | 02/09/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71005206A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |