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General NPI Number Information
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NPI Number | 1679964001
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Entity Type | Individual
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Provider Name | WAYNE PRESUTTI FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/06/2015
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Last Update Date | 02/06/2015
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Provider Practice Location Address
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Address Line | 2330 INDIANAPOLIS BLVD
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City | WHITING
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State | IN
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Zip | 46394-1956
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Country | US
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Telephone | 219-659-0333
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Fax | 219-659-0336
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Provider Business Mailing Address
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Address Line | 2330 INDIANAPOLIS BLVD
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City | WHITING
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State | IN
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Zip | 46394-1956
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Country | US
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Telephone | 219-659-0333
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Fax | 219-659-0336
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28183640A
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License Number State | IN
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