Healthcare Provider Details

I. General information

NPI: 1619291358
Provider Name (Legal Business Name): ANDREA LYNN WOJDYLA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA LILLIE

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-5890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number088212
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28202194A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: