Provider Demographics
NPI:1316176258
Name:NODINE, FREDERICA ANN (NP-C)
Entity type:Individual
Prefix:
First Name:FREDERICA
Middle Name:ANN
Last Name:NODINE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 N MAIN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:BLUFFTON
Mailing Address - State:IN
Mailing Address - Zip Code:46714-2041
Mailing Address - Country:US
Mailing Address - Phone:260-353-3375
Mailing Address - Fax:260-353-3377
Practice Address - Street 1:360 N MAIN ST
Practice Address - Street 2:SUITE E
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2041
Practice Address - Country:US
Practice Address - Phone:260-353-3375
Practice Address - Fax:260-353-3377
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF0609289363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily