Provider Demographics
NPI:1730113606
Name:LOTTES, NOELLE C (RN FNP)
Entity Type:Individual
Prefix:MS
First Name:NOELLE
Middle Name:C
Last Name:LOTTES
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 WINDFLOWER PL
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-6616
Mailing Address - Country:US
Mailing Address - Phone:765-441-2096
Mailing Address - Fax:
Practice Address - Street 1:938 MEZZANINE DR STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8641
Practice Address - Country:US
Practice Address - Phone:765-742-1533
Practice Address - Fax:765-742-1824
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2023-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001576A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000599459OtherANTHEM PROVIDER NUMBER
IN200852880Medicaid
IN200852880Medicaid