Individual
JESSICA L. OTTENWELLER-BUTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2512 E DUPONT RD STE 200, FORT WAYNE, IN 46825-1609
(260) 458-3760
(260) 458-3761
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01064357A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000615710
BLUE CROSS BLUE SHIELD
—
05
—
200941590
—
IN
01
—
P01390392
RAILROAD MEDICARE
IN
Enumeration date
08/10/2006
Last updated
12/21/2020
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