Healthcare Provider Details

I. General information

NPI: 1013496736
Provider Name (Legal Business Name): CZARINA S CASTILLO BOEDEKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MA CZARINA S CASTILLO FNP-C

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 CLEARVISTA DR STE 380
INDIANAPOLIS IN
46256-5608
US

IV. Provider business mailing address

7250 CLEARVISTA DR STE 380
INDIANAPOLIS IN
46256-5608
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-3700
  • Fax: 317-621-3701
Mailing address:
  • Phone: 317-621-3700
  • Fax: 317-621-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28197056A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008343A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: