Provider Demographics
NPI:1750996757
Name:OTTERBEIN, AIMEE C (FNP)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:C
Last Name:OTTERBEIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:C
Other - Last Name:HEYDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6033
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-6033
Mailing Address - Country:US
Mailing Address - Phone:317-827-2987
Mailing Address - Fax:317-219-0879
Practice Address - Street 1:13655 SMOKEY RIDGE PL
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9265
Practice Address - Country:US
Practice Address - Phone:317-827-2987
Practice Address - Fax:317-219-0879
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010377A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily