MEDICARE: BIANCA OSAKWE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71014547A	IN
2	363LF0000X	Family Nurse Practitioner	AP130235	TX

General Provider Information

NPI Number	:	1649638388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA OSAKWE

Provider Business Mailing Address
First Line	:	2620 KESSLER BOULEVARD EAST DR STE 110
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2889
Country	:	US
Telephone Number	:
Fax Number	:	865-409-5932

Provider Business Practice Location Address
First Line	:	2620 KESSLER BOULEVARD EAST DR STE 110
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2889
Country	:	US
Telephone Number	:	800-336-1100
Fax Number	:	865-409-5932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2016
Last Update Date	:	12/14/2023

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