Provider Demographics
NPI:1659654929
Name:NUFER, MICHAELA B (NNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:B
Last Name:NUFER
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:A
Other - Last Name:BRINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:600 EAST BLVD
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2483
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:WEST WING
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-2751
Practice Address - Fax:574-389-4840
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28068582A163WN0002X, 163WN0003X
IN71003932A363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No163WN0003XNursing Service ProvidersRegistered NurseNeonatal, Low-Risk
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000734846OtherANTHEM
IN201037120Medicaid
IN28068582AOtherRN LICENSE
INNUF104285891OtherNCC NEONATAL NURSE PRACTITIONER CERTIFICATION
INM400074509Medicare PIN