Provider Demographics
NPI:1912018508
Name:MEDING, PATTY A
Entity Type:Individual
Prefix:
First Name:PATTY
Middle Name:A
Last Name:MEDING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 86TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6258
Mailing Address - Country:US
Mailing Address - Phone:219-756-1407
Mailing Address - Fax:219-756-1410
Practice Address - Street 1:200 E 86TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6258
Practice Address - Country:US
Practice Address - Phone:219-756-1400
Practice Address - Fax:219-756-1410
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001837A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200521390Medicaid
IN200521390Medicaid
IN406310XMedicare ID - Type Unspecified