Individual ProviderVicki L BahlsNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address2518 E Dupont Rd, Fort Wayne, IN 46825-1675(260) 432-4400PECOS EnrollmentBased on the most recent information from CMS, provider Vicki L Bahls does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1619962198Provider TypeIndividualFull NameBahls, Vicki LCredentialNPGenderFemaleSole ProprietorNoEnumeration Date9/12/2005Last Updated3/5/2014Contact InformationPractice LocationPractice Address2518 E Dupont Rd, Fort Wayne, IN 46825-1675Phone(260) 432-4400Fax(260) 969-6898Mailing LocationMailing Address2518 E Dupont Rd, Fort Wayne, IN 46825-1675Phone(260) 432-4400Fax(260) 969-6898Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense71000085IndianaCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense28058063AIndianaProvider IdentifiersIDDescriptionIssuerID500020063DescriptionOtherIssuerRAIL ROAD MEDICAREIndianaID200351030DescriptionMedicaidIssuerUnlistedIndiana