Healthcare Provider Details

I. General information

NPI: 1518050426
Provider Name (Legal Business Name): HOLLY P WYSS RN, CS, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8233 RAILROAD RD
INDIANAPOLIS IN
46217-4576
US

IV. Provider business mailing address

8233 RAILROAD RD
INDIANAPOLIS IN
46217-4576
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-2610
  • Fax: 317-887-2636
Mailing address:
  • Phone: 317-887-2610
  • Fax: 317-887-2636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001532A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: