MEDICARE: CANDACE HOUSTON DEYERLING FNP-C

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	363LF0000X	Family Nurse Practitioner	4704380953	MI
2	363LF0000X	Family Nurse Practitioner	71010998A	IN
3	363LF0000X	Family Nurse Practitioner	0993200	CO

General Provider Information

NPI Number	:	1720502057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE HOUSTON DEYERLING FNP-C

Provider Business Mailing Address
First Line	:	201 N ILLINOIS ST
Second Line	:	16TH FLOOR-SOUTH TOWER
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1904
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N ILLINOIS ST FL 16
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1904
Country	:	US
Telephone Number	:	888-731-8994
Fax Number	:

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

Provider Enumeration Date	:	07/28/2017
Last Update Date	:	12/14/2025

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