MEDICARE: LATONYA L SULTZER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71006098A	IN
2	261QP2300X	Primary Care Clinic/Center	28157480A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01678747	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28157480A	OTHER	IN	INDIANA PROFESSIONAL LICENSING AGENCY NURSING BOARD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659744126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATONYA L SULTZER

Provider Business Mailing Address
First Line	:	1002 N MITTHOEFER RD STE A
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2461
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 N ARLINGTON AVE
Second Line	:	SUITE B
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-3361
Country	:	US
Telephone Number	:	317-355-9431
Fax Number	:	317-355-9445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2015
Last Update Date	:	04/29/2026

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Directions to “ LATONYA L SULTZER ” Practice Location

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