Healthcare Provider Details

I. General information

NPI: 1255580635
Provider Name (Legal Business Name): ANNETTE L DEWITT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 11/27/2023
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 N MERIDIAN ST SUITE 202
INDIANAPOLIS IN
46260-1872
US

IV. Provider business mailing address

9333 N MERIDIAN ST SUITE 202
INDIANAPOLIS IN
46260-1872
US

V. Phone/Fax

Practice location:
  • Phone: 317-580-9333
  • Fax: 317-818-8933
Mailing address:
  • Phone: 317-580-9333
  • Fax: 317-818-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002555A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: