Individual
AIMEE CLADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1915 LAKE AVE, PLYMOUTH, IN 46563-9366
(574) 948-4000
Mailing address
16310 PRETTY LAKE RD, PLYMOUTH, IN 46563-9458
(574) 780-0354
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28123070A
IN
363LF0000X
Family Nurse Practitioner
Primary
71007043A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001075406
BCBS
IN
01
—
187720013
MEDICARE
IN
05
—
300002047
—
IN
Enumeration date
02/13/2017
Last updated
02/28/2020
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