MEDICARE: WELL INFUSED, LLC

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	261QH0100X	Health Service Clinic/Center
2	363L00000X	Nurse Practitioner

General Provider Information

NPI Number	:	1477204550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELL INFUSED, LLC

Provider Business Mailing Address
First Line	:	14297 BERGEN BLVD STE 125
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3420
Country	:	US
Telephone Number	:	317-674-8857
Fax Number	:

Provider Business Practice Location Address
First Line	:	14297 BERGEN BLVD STE 125
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46060-3420
Country	:	US
Telephone Number	:	317-674-8857
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PARTNER
Name	:	DR. STACI J BLUME
Credential	:	DC
Telephone Number	:	317-674-8857

Provider Enumeration Date	:	01/11/2022
Last Update Date	:	10/17/2022

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Directions to “WELL INFUSED, LLC ” Practice Location

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