Healthcare Provider Details

I. General information

NPI: 1467118034
Provider Name (Legal Business Name): REBECCA KRILICH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: REBECCA TORTOLANO

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15900 W 101ST AVE
DYER IN
46311-3065
US

IV. Provider business mailing address

15900 W 101ST AVE
DYER IN
46311-3065
US

V. Phone/Fax

Practice location:
  • Phone: 219-365-6333
  • Fax:
Mailing address:
  • Phone: 219-365-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011778A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: