Individual
WENDY RENEE DUTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
400 TEEGARDEN ST, LA PORTE, IN 46350-3175
(219) 326-0043
(219) 326-8909
Mailing address
400 TEEGARDEN ST, LA PORTE, IN 46350-3175
(219) 326-0043
(219) 326-8909
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28160815A
IN
363L00000X
Nurse Practitioner
28160815A
IN
363L00000X
Nurse Practitioner
Primary
71004235A
IN
363LF0000X
Family Nurse Practitioner
71004235A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
151020022
MEDICARE PTAN
IN
05
—
201149460
—
IN
01
—
25-9860003
MEDICARE PTAN
IN
Enumeration date
10/09/2012
Last updated
12/15/2023
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