Provider Demographics
NPI:1053866921
Name:WOEBKENBERG, AMY B (NP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:B
Last Name:WOEBKENBERG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:WETZEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2598 W WHITE RIVER BLVD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-5251
Practice Address - Country:US
Practice Address - Phone:765-747-3888
Practice Address - Fax:765-288-6139
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006471A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ2614153OtherMEDICARE PTAN
IN264430550OtherMEDICARE PTAN
IN000001074332OtherANTHEM PTAN
IN201392420Medicaid