IndividualActive
Kelli Bacon
NPI 1558056655 · General Practice Registered Nurse · Mishawaka, IN
Provider details
- NPI number
- 1558056655
- Entity type
- Individual
- Primary specialty
- General Practice Registered NurseNursing Service Providers
- Sex
- Female
- Sole proprietor
- No
- License
- 28188683A (IN)
Specialties & taxonomies
Nursing Service Providers
Practice location
1540 Trinity Pl
Mishawaka, IN 46545-5006
Phone: (574) 272-9000
Approximate (ZIP-level) locationGet directions
Mailing address
1540 Trinity Pl
Mishawaka, IN 46545-5006
Registry dates
- Enumerated
- 2023-04-06
- Last updated
- 2023-04-06
- Certified
- 2023-04-06
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.