Provider Demographics
NPI:1992293187
Name:WISEHART, AMBER MARIE (FNP)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE
Last Name:WISEHART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8101 CLEARVISTA PKWY STE 185
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46256-4691
Mailing Address - Country:US
Mailing Address - Phone:317-621-9000
Mailing Address - Fax:
Practice Address - Street 1:8101 CLEARVISTA PKWY STE 185
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:IN
Practice Address - Zip Code:46256-4691
Practice Address - Country:US
Practice Address - Phone:317-621-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28204696A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily