Healthcare Provider Details

I. General information

NPI: 1497524276
Provider Name (Legal Business Name): ANDREA VAN DYKE BATEMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDEE V BATEMAN RN

II. Dates (important events)

Enumeration Date: 12/21/2023
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

21238 CARLTON CT
NOBLESVILLE IN
46062-8001
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-3321
  • Fax:
Mailing address:
  • Phone: 317-501-8426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28200336A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28200336A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: