MEDICARE: MRS. CREOLE MARIE DYCUS FNP, APRN, BC

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	363LF0000X	Family Nurse Practitioner	71000360A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11446468	OTHER	IN	CAQH

General Provider Information

NPI Number	:	1689643538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CREOLE MARIE DYCUS FNP, APRN, BC

Provider Business Mailing Address
First Line	:	11319 SHOREVIEW LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-8625
Country	:	US
Telephone Number	:	317-823-1709
Fax Number	:

Provider Business Practice Location Address
First Line	:	11845 ALLISONVILLE RD
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-2313
Country	:	US
Telephone Number	:	317-842-2727
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	09/27/2012

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