Healthcare Provider Details

I. General information

NPI: 1992635494
Provider Name (Legal Business Name): NICHOLAS MAYHEW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 KEYSTONE WAY
CARMEL IN
46032-2823
US

IV. Provider business mailing address

973 KEYSTONE WAY
CARMEL IN
46032-2823
US

V. Phone/Fax

Practice location:
  • Phone: 317-674-6552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28259708A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: