Individual
JENNA MICHELE MOTYCKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
600 MARY STREET, EVANSVILLE, IN 47747-2306
(812) 450-3405
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71003453A
IN
363LF0000X
Family Nurse Practitioner
28164496A
IN
363LF0000X
Family Nurse Practitioner
Primary
3007267
KY
363LF0000X
Family Nurse Practitioner
71003453A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201014300
—
IN
05
—
7100188900
—
KY
Enumeration date
11/02/2010
Last updated
02/23/2021
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