Healthcare Provider Details

I. General information

NPI: 1982936175
Provider Name (Legal Business Name): KRISTA SCHWUCHOW NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2010
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3403 E RAYMOND ST
INDIANAPOLIS IN
46203-4744
US

IV. Provider business mailing address

3908 MEADOWS DR
INDIANAPOLIS IN
46205-3114
US

V. Phone/Fax

Practice location:
  • Phone: 317-957-2000
  • Fax: 317-957-2050
Mailing address:
  • Phone: 317-957-2150
  • Fax: 317-957-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number71005350A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71005350A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: