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General NPI Number Information
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NPI Number | 1639274848
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Entity Type | Individual
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Provider Name | JODI ANN HETTERMANN BLUME PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 5510 SOUTH EAST ST BUILDING A SUITE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46227
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Country | US
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Telephone | 317-228-7000
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Fax | 317-228-2321
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Provider Business Mailing Address
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Address Line | 5510 S EAST ST BUILDING A SUITE B
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1939
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Country | US
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Telephone | 317-228-7000
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Fax | 317-228-9029
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10000571A
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License Number State | IN
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