Provider Demographics
NPI:1093773061
Name:MRAVCA-WILKEY, VICKI L (NP)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:L
Last Name:MRAVCA-WILKEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:L
Other - Last Name:MRAVCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7250 CLEARVISTA DR STE 260
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256
Practice Address - Country:US
Practice Address - Phone:317-621-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000496363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01198020OtherRR MEDICARE PTAN
IN100120320Medicaid
INP01198020OtherRR MEDICARE PTAN
INS59364Medicare UPIN
IN100120320Medicaid