Healthcare Provider Details

I. General information

NPI: 1689481434
Provider Name (Legal Business Name): RISE WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2024
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 NIGHTHAWK WAY
INDIANAPOLIS IN
46254-4771
US

IV. Provider business mailing address

3250A W 86TH ST # 1242
INDIANAPOLIS IN
46268-3605
US

V. Phone/Fax

Practice location:
  • Phone: 317-965-0299
  • Fax:
Mailing address:
  • Phone: 317-965-0299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NYLA FLEMING
Title or Position: OWNER, PROVIDER
Credential: NP
Phone: 317-965-0299