Healthcare Provider Details

I. General information

NPI: 1801673520
Provider Name (Legal Business Name): VINCENT IAN MARKOWICZ NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 DECATUR BLVD
INDIANAPOLIS IN
46241-9561
US

IV. Provider business mailing address

6067 DECATUR BLVD
INDIANAPOLIS IN
46241-9606
US

V. Phone/Fax

Practice location:
  • Phone: 317-455-2366
  • Fax:
Mailing address:
  • Phone: 317-856-5201
  • Fax: 317-455-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28220903A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014394A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28220903A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: