Healthcare Provider Details

I. General information

NPI: 1497564231
Provider Name (Legal Business Name): ALI M FIEDLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALI M PETRIKO RN

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD # UH-1501
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

550 UNIVERSITY BLVD # UH-1501
INDIANAPOLIS IN
46202-5149
US

V. Phone/Fax

Practice location:
  • Phone: 179-480-7623
  • Fax: 317-948-0503
Mailing address:
  • Phone: 179-480-7623
  • Fax: 317-948-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71016120A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number71016120A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: