Healthcare Provider Details

I. General information

NPI: 1144138736
Provider Name (Legal Business Name): LEVI WONDEYEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 N MAIN ST
CROWN POINT IN
46307-1877
US

IV. Provider business mailing address

2100 N MAIN ST
CROWN POINT IN
46307-1877
US

V. Phone/Fax

Practice location:
  • Phone: 574-546-1900
  • Fax: 574-546-1999
Mailing address:
  • Phone: 574-546-1900
  • Fax: 574-546-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71018605A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71018605B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: