Provider Demographics
NPI:1679964001
Name:PRESUTTI, WAYNE (FNP-BC)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:PRESUTTI
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 INDIANAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITING
Mailing Address - State:IN
Mailing Address - Zip Code:46394-1956
Mailing Address - Country:US
Mailing Address - Phone:219-659-0333
Mailing Address - Fax:219-659-0336
Practice Address - Street 1:2330 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1956
Practice Address - Country:US
Practice Address - Phone:219-659-0333
Practice Address - Fax:219-659-0336
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28183640A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily