Provider Demographics
NPI:1467935908
Name:WITTKE, AMBER MICHELLE (FNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:MICHELLE
Last Name:WITTKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:MICHELLE
Other - Last Name:SUTFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8360 S EMERSON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8746
Mailing Address - Country:US
Mailing Address - Phone:317-859-2535
Mailing Address - Fax:317-859-2540
Practice Address - Street 1:8360 S EMERSON AVE STE 100
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8746
Practice Address - Country:US
Practice Address - Phone:317-859-2535
Practice Address - Fax:317-859-2540
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28157878A163W00000X
IN71008582A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN30021355Medicaid