Provider Demographics
NPI:1982936175
Name:SCHWUCHOW, KRISTA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:SCHWUCHOW
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-3114
Mailing Address - Country:US
Mailing Address - Phone:317-957-2150
Mailing Address - Fax:317-957-2160
Practice Address - Street 1:3403 E RAYMOND ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-4744
Practice Address - Country:US
Practice Address - Phone:317-957-2000
Practice Address - Fax:317-957-2050
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005350A2084A0401X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine