Provider Demographics
NPI:1811910839
Name:RATCLIFF, NORDA A (NP)
Entity type:Individual
Prefix:
First Name:NORDA
Middle Name:A
Last Name:RATCLIFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3443 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-4851
Mailing Address - Country:US
Mailing Address - Phone:812-353-3443
Mailing Address - Fax:812-353-3442
Practice Address - Street 1:2900 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3510
Practice Address - Country:US
Practice Address - Phone:812-275-9675
Practice Address - Fax:812-275-1232
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001385A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200175600Medicaid
IN200175600Medicaid
IN200175600Medicaid
549350HMedicare ID - Type Unspecified
IN15-3884Medicare PIN
P77038Medicare UPIN
IN200874400Medicaid