Healthcare Provider Details

I. General information

NPI: 1548848922
Provider Name (Legal Business Name): ELIZABETH NETTLETON DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 E STOP 11 RD STE 320
INDIANAPOLIS IN
46237-6341
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1008
US

V. Phone/Fax

Practice location:
  • Phone: 317-888-1467
  • Fax: 317-888-1476
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036169483
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number02009202A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: