Provider Demographics
NPI:1023115375
Name:WOESTE, ROBERTA (FNP)
Entity type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:WOESTE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 N COUNTY ROAD 1050 E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46117-9728
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:695 N COUNTY ROAD 1050 E
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46117-9728
Practice Address - Country:US
Practice Address - Phone:317-467-9116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000641A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200459610Medicaid
INM400052164Medicare PIN
INM400048007Medicare PIN
INM400048020Medicare PIN
INM400048015Medicare PIN
INM400053549Medicare PIN
INM400048018Medicare PIN
INM400047970Medicare PIN
INM400048017Medicare PIN