1679808919 NPI number — RAM KHATTRI CHETTRI FNP-C, MS, MATS, RN

Table of content: RAM KHATTRI CHETTRI FNP-C, MS, MATS, RN (NPI 1679808919)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679808919 NPI number — RAM KHATTRI CHETTRI FNP-C, MS, MATS, RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KHATTRI CHETTRI
Provider First Name:
RAM
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C, MS, MATS, RN
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679808919
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 S MAIN STREET
Provider Second Line Business Mailing Address:
SUITE A, HEART & VASCULAR CENTER
Provider Business Mailing Address City Name:
GOSHEN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46526-4723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-533-7476
Provider Business Mailing Address Fax Number:
574-538-5147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1855 S MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE A, HEART & VASCULAR CENTER
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46526-4723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-533-7476
Provider Business Practice Location Address Fax Number:
574-538-5147
Provider Enumeration Date:
10/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  28166834A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200959670 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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