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Nicole Leigh Fornalik, PA-C
Physician Assistant in Mishawaka, Indiana
NPI 1982635587

Nicole Leigh Fornalik is a Physician Assistant based in South Bend, IN. Nicole Leigh Fornalik practices in Mishawaka, IN and has the professional credentials of PA-C. The NPI Number for Nicole Leigh Fornalik is 1982635587 and holds a License No. 10000784A (Indiana).

The current practice location address for Nicole Leigh Fornalik is 5340 Holy Cross Pkwy, Mishawaka, IN and can be reached out via phone at 574-237-1328 and via fax at 574-237-1348. You can also correspond with Nicole Leigh Fornalik through the mailing address at 100 E WAYNE ST STE 510, SOUTH BEND, IN - 46601-2394 (mailing address contact number: 574-334-5400).

Location: 5340 Holy Cross Pkwy, Mishawaka, IN, 46601-2394
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1982635587
Provider Name
Nicole Leigh Fornalik
Credential
PA-C
Provider Entity Type
Individual
Gender
Female
Address
5340 Holy Cross Pkwy, Mishawaka, IN, 46601-2394
Phone Number
574-237-1328
Fax Number
574-237-1348
Provider Enumeration Date
07/05/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
300007442 05 IN
institution
Provider Business Practice Location Address Details
Address
5340 Holy Cross Pkwy
City
Mishawaka
State
Indiana
Zip
46545-1470
Phone Number
574-237-1328
Fax Number
574-237-1348
person
Provider Business Mailing Address Details
Address
100 E Wayne St Ste 510
City
South Bend
State
Indiana
Zip
46601-2394
Phone Number
574-334-5400
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
-
Taxonomy
363A00000X
License No.
10000784A (Indiana)
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
10000784A (Indiana)
Definition
Definition to come...
person
Provider's Taxonomy Details 3
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Surgical
Taxonomy
363AS0400X
License No.
10000784A (Indiana)
Definition
Definition to come...
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