Healthcare Provider Details

I. General information

NPI: 1467935908
Provider Name (Legal Business Name): AMBER MICHELLE WITTKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER MICHELLE SUTFIN

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2732 W MICHIGAN ST
INDIANAPOLIS IN
46222-3750
US

IV. Provider business mailing address

PO BOX 637764
CINCINNATI OH
45263-7764
US

V. Phone/Fax

Practice location:
  • Phone: 317-554-4600
  • Fax: 317-554-4617
Mailing address:
  • Phone: 317-880-3939
  • Fax: 317-880-0343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71008582A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28157878A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008582A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: