Provider Demographics
NPI:1952461782
Name:OETKEN, ANNETTE YVONNE (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:YVONNE
Last Name:OETKEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:YVONNE
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1102 N COUNTY ROAD 700
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IL
Mailing Address - Zip Code:62379-3011
Mailing Address - Country:US
Mailing Address - Phone:217-256-4100
Mailing Address - Fax:217-256-3800
Practice Address - Street 1:1102 N COUNTY ROAD 700
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IL
Practice Address - Zip Code:62379-3011
Practice Address - Country:US
Practice Address - Phone:217-256-4100
Practice Address - Fax:217-256-3800
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3003207Q00000X
IL036147640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1952461782Medicaid
IA54385OtherWELLMARK BCBS OF IOWA
IA1952461782OtherWELLMARK BLUE CROSS BLUE SHIELF
IA54385OtherWELLMARK BCBS OF IOWA
IA1952461782OtherWELLMARK BLUE CROSS BLUE SHIELF