Provider Demographics
NPI:1861879264
Name:RACZ, JOYCE ELLEN (MSN, FNP-C, RN)
Entity type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:ELLEN
Last Name:RACZ
Suffix:
Gender:F
Credentials:MSN, FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:621 MEMORIAL DR STE 402
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1074
Practice Address - Country:US
Practice Address - Phone:574-647-2500
Practice Address - Fax:574-647-7170
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28082633A363L00000X
IN71005543363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201315860Medicaid
IN000000955116OtherBCBS CENTENNIAL NEIGHBORHOOD HEALTH CENTER
IN201315860Medicaid