Healthcare Provider Details

I. General information

NPI: 1457331522
Provider Name (Legal Business Name): FETTERS HEALTH AND WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 USA PARKWAY SUITE 205
FISHERS IN
46038
US

IV. Provider business mailing address

11201 USA PARKWAY SUITE 205
FISHERS IN
46038
US

V. Phone/Fax

Practice location:
  • Phone: 317-913-8170
  • Fax: 317-913-8184
Mailing address:
  • Phone: 317-913-8170
  • Fax: 317-913-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01034557A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01034557A
License Number StateIN

VIII. Authorized Official

Name: MS. CAROLYN ROSE DVORAK
Title or Position: ADMINISTRATOR
Credential:
Phone: 317-913-8170