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General NPI Number Information
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NPI Number | 1760633267
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Entity Type | Individual
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Provider Name | PATRICIA R FETTIG NP
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Gender | Female
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 01/31/2017
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Provider Practice Location Address
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Address Line | 10731 N STATE ROAD 13
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City | ELWOOD
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State | IN
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Zip | 46036-8874
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Country | US
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Telephone | 765-552-5009
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Fax | 765-552-8347
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Provider Business Mailing Address
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Address Line | 9615 E 148TH ST SUITE 1
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City | NOBLESVILLE
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State | IN
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Zip | 46060-4360
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Country | US
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Telephone | 317-587-0500
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Fax | 317-674-0060
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71002768A
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License Number State | IN
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