Provider Demographics
NPI:1265490569
Name:ALTMAN, BEVERLY E (NP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:E
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13100 E 136TH ST STE 3000
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9817
Practice Address - Country:US
Practice Address - Phone:317-678-3900
Practice Address - Fax:317-678-3910
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000308A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200233040Medicaid
IN200233040Medicaid
INP01254549Medicare PIN
INM400061235Medicare PIN
IN218650IMedicare PIN
IN264430061Medicare PIN