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General NPI Number Information
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NPI Number | 1861284416
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Entity Type | Organization
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Legal Business Name | MOSAIC HEALTHCARE LLC
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Dates
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Enumeration Date | 05/20/2025
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 2607 S 700 W
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City | RUSSIAVILLE
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State | IN
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Zip | 46979-9415
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Country | US
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Telephone | 765-480-8213
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Fax |
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Provider Business Mailing Address
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Address Line | 2607 S 700 W
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City | RUSSIAVILLE
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State | IN
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Zip | 46979-9415
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Country | US
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Telephone | 765-860-9857
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Fax | 877-821-5463
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY LAY-WOLF
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Credential | FNP-BC
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Telephone | 765-480-8213
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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 |
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License Number State |
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