Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 71002083A | IN |
N | 363LP0222X | Nurse Practitioner Pediatrics (Critical Care) | 71002083A | IN |
NPI | 1043405178 |
---|---|
Provider Name | Mrs. Kelly Marie Batthauer |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46260-2053 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 14/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201005130 | (05) | IN |