Healthcare Provider Details

I. General information

NPI: 1386589562
Provider Name (Legal Business Name): ERIN NAUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ERIN WETZOLD

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6812 MARMONT CT
INDIANAPOLIS IN
46220-4234
US

IV. Provider business mailing address

6812 MARMONT CT
INDIANAPOLIS IN
46220-4234
US

V. Phone/Fax

Practice location:
  • Phone: 317-460-4161
  • Fax:
Mailing address:
  • Phone: 317-460-4161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28243018C
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: