Provider Demographics
NPI:1841287299
Name:PAUNICKA, NANCY JANE (RN MS-FNP-CS)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JANE
Last Name:PAUNICKA
Suffix:
Gender:F
Credentials:RN MS-FNP-CS
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:JANE
Other - Last Name:HOGLUND-PAUNICKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MS-FNP-CS
Mailing Address - Street 1:PO BOX 1690
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46352-1690
Mailing Address - Country:US
Mailing Address - Phone:219-326-2312
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:3777 NORTH FRONTAGE ROAD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7694
Practice Address - Country:US
Practice Address - Phone:219-877-3880
Practice Address - Fax:219-879-6365
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000141A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000772332OtherANTHEM BCBS
INM400075623OtherMEDICARE PTAN
IN200083140Medicaid
IN200083140Medicaid