Provider Demographics
NPI:1306898747
Name:OTTINGER, LANCE KEITH (ANP)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:KEITH
Last Name:OTTINGER
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 W UNIVERSITY AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-3421
Mailing Address - Country:US
Mailing Address - Phone:765-289-6381
Mailing Address - Fax:
Practice Address - Street 1:2525 W UNIVERSITY AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-3421
Practice Address - Country:US
Practice Address - Phone:765-289-6381
Practice Address - Fax:765-289-3883
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001355A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00968563OtherRR MEDICARE
IN200393180Medicaid
INM400041125Medicare PIN
INP00968563OtherRR MEDICARE
IN200393180Medicaid