MEDICARE: MRS. SUE ELLYN NOTTINGHAM FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71000515	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000666143	OTHER	IN	BLUE CROSS

General Provider Information

NPI Number	:	1891853644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUE ELLYN NOTTINGHAM FNP

Provider Business Mailing Address
First Line	:	10330 N MERIDIAN ST # 300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11530 ALLISONVILLE RD STE 100
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-1862
Country	:	US
Telephone Number	:	317-415-5900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	10/26/2017

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