Healthcare Provider Details

I. General information

NPI: 1235065228
Provider Name (Legal Business Name): VENISHA WALLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5747 ENSLEY CT
INDIANAPOLIS IN
46254-4957
US

IV. Provider business mailing address

PO BOX 53531
INDIANAPOLIS IN
46253-0531
US

V. Phone/Fax

Practice location:
  • Phone: 317-418-9322
  • Fax: 317-974-9750
Mailing address:
  • Phone: 317-418-9322
  • Fax: 317-974-9750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number260189831
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: