Healthcare Provider Details

I. General information

NPI: 1619590015
Provider Name (Legal Business Name): ALLYSON FRIEDERICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLYSON S FRIEDERICH

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

PO BOX 778912
CHICAGO IL
60677-8912
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-2563
  • Fax: 317-222-2154
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number28229935A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010107A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: