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General NPI Number Information
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NPI Number | 1699652545
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Entity Type | Individual
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Provider Name | GRANT WYSONG
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Gender | Male
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Dates
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Enumeration Date | 08/20/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 7250 CLEARVISTA DR STE 355
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-5609
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Country | US
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Telephone | 317-621-6262
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Fax |
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Provider Business Mailing Address
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Address Line | 6626 E 75TH ST STE 500
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2890
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Country | US
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Telephone | 317-621-1699
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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 | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 28222590A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LC0200X
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Taxonomy Name | Critical Care Medicine Nurse Practitioner
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License Number | 71016996A
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License Number State | IN
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