Healthcare Provider Details

I. General information

NPI: 1164134805
Provider Name (Legal Business Name): EVELYN OLEJNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SOUTHFIELD DR STE 1370
PLAINFIELD IN
46168-4300
US

IV. Provider business mailing address

8135 E COUNTY ROAD 700 N
BROWNSBURG IN
46112-9016
US

V. Phone/Fax

Practice location:
  • Phone: 317-839-7200
  • Fax:
Mailing address:
  • Phone: 317-489-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004629A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: