Individual
PATRICIA R FETTIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10731 N STATE ROAD 13, ELWOOD, IN 46036-8874
(765) 552-5009
(765) 552-8347
Mailing address
9615 E 148TH ST, SUITE 1, NOBLESVILLE, IN 46060-4360
(317) 587-0500
(317) 674-0060
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71002768A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000802585
ANTHEM
IN
05
—
201006170
—
IN
Enumeration date
10/02/2008
Last updated
01/31/2017
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