Graciela Jimenez-Martinez, NP
Individual provider Active NPI Family Nurse Practitioner · Bremen, IN
NPI 1447737002 · NPPES record last updated Nov 19, 2022
Key facts
- NPI
- 1447737002
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 71008159A (IN)
- Practice address
- 1217 W Plymouth St
Bremen, IN 46506-1930 - Phone
- (574) 546-0654
- Fax
- (888) 815-1434
- NPI assigned
- Jul 25, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28192998A | IN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michiana Concierge Family Medicine | Registered Nurse | Current |
Accepting new patients |
Locations
1217 W Plymouth St
Bremen, IN 46506
Phone (574) 546-0654
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/CFFDCD/Endpoint/CFFDCD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28192998A | IN | |
| Family Nurse Practitioner | 363LF0000X | 71008159A | IN | Yes |
Addresses
Primary practice location
1217 W Plymouth St
Bremen, IN 46506-1930
Mailing address
316 N Montgomery St
Bremen, IN 46506-1156
Phone (574) 209-1130
Other providers in Bremen, IN
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- Kevin R Hickman
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All providers in Bremen, IN · Family Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.