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General NPI Number Information
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NPI Number | 1235320649
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Entity Type | Organization
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Legal Business Name | ITS YOUR BODY INC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 8233 RAILROAD RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-4576
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Country | US
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Telephone | 317-887-2610
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Fax | 317-887-2636
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Provider Business Mailing Address
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Address Line | 8233 RAILROAD RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46217-4576
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Country | US
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Telephone | 317-887-2610
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Fax | 317-887-2636
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Authorized Official
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Title or Position | OWNER
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Name | MISS HOLLY PATRICE WYSS
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Credential | FNP-C
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Telephone | 317-887-2610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 71001532A
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License Number State | IN
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