MEDICARE: IBITAYO K ARISE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71014315A	IN

General Provider Information

NPI Number	:	1104699263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IBITAYO K ARISE

Provider Business Mailing Address
First Line	:	8471 BALLYSHANNON DR
Second Line	:
City	:	BROWNSBURG
State	:	IN
Zip	:	46112-7320
Country	:	US
Telephone Number	:	317-985-5899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 SHORE DR STE 315
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-4693
Country	:	US
Telephone Number	:	317-429-0061
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	11/01/2023

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Directions to “ IBITAYO K ARISE ” Practice Location

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