Individual
LANCE KEITH OTTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ANP
Contact information
Practice address
2525 W UNIVERSITY AVE, SUITE 403, MUNCIE, IN 47303-3421
(765) 289-6381
(765) 289-3883
Mailing address
2525 W UNIVERSITY AVE, SUITE 403, MUNCIE, IN 47303-3421
(765) 289-6381
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71001355A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200393180
—
IN
01
—
P00968563
RR MEDICARE
IN
Enumeration date
05/16/2006
Last updated
10/25/2011
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