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General NPI Number Information
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NPI Number | 1093209009
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Entity Type | Individual
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Provider Name | YELIZAVETA VAYL AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/22/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 2010 W 86TH ST STE 111
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City | INDIANAPOLIS
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State | IN
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Zip | 46260
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Country | US
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Telephone | 317-415-6580
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 N MERIDIAN ST # 300
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City | INDIANAPOLIS
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State | IN
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Zip | 46290-1024
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71008168A
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License Number State | IN
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