Provider Demographics
NPI:1679808919
Name:KHATTRI CHETTRI, RAM (FNP-C, MS, MATS, RN)
Entity Type:Individual
Prefix:
First Name:RAM
Middle Name:
Last Name:KHATTRI CHETTRI
Suffix:
Gender:M
Credentials:FNP-C, MS, MATS, RN
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Mailing Address - Street 1:1855 S MAIN STREET
Mailing Address - Street 2:SUITE A, HEART & VASCULAR CENTER
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4723
Mailing Address - Country:US
Mailing Address - Phone:574-533-7476
Mailing Address - Fax:574-538-5147
Practice Address - Street 1:1855 S MAIN STREET
Practice Address - Street 2:SUITE A, HEART & VASCULAR CENTER
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4723
Practice Address - Country:US
Practice Address - Phone:574-533-7476
Practice Address - Fax:574-538-5147
Is Sole Proprietor?:No
Enumeration Date:2009-10-05
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28166834A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200959670Medicaid
IN200959670Medicaid