Provider Demographics
NPI:1417923756
Name:STEINMETZ, THERESE MARIE (MSN, PNP)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:STEINMETZ
Suffix:
Gender:F
Credentials:MSN, PNP
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:MARIE
Other - Last Name:CARLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, PNP
Mailing Address - Street 1:3355 DOUGLAS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1781
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 NAVARRE PL
Practice Address - Street 2:SUITE 4440
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1156
Practice Address - Country:US
Practice Address - Phone:574-647-4540
Practice Address - Fax:574-647-4542
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002075A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200804970Medicaid
IN228880CMedicare PIN
IN182870KMedicare PIN
IN200804970Medicaid