Healthcare Provider Details

I. General information

NPI: 1750996757
Provider Name (Legal Business Name): AIMEE C OTTERBEIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AIMEE C HEYDE

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13655 SMOKEY RIDGE PL
CARMEL IN
46033-9265
US

IV. Provider business mailing address

PO BOX 6033
FISHERS IN
46038-6033
US

V. Phone/Fax

Practice location:
  • Phone: 317-827-2987
  • Fax: 317-219-0879
Mailing address:
  • Phone: 317-827-2987
  • Fax: 317-219-0879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010377A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: