Provider Demographics
NPI:1235320649
Name:ITS YOUR BODY INC
Entity Type:Organization
Organization Name:ITS YOUR BODY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:PATRICE
Authorized Official - Last Name:WYSS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:317-887-2610
Mailing Address - Street 1:8233 RAILROAD RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-4576
Mailing Address - Country:US
Mailing Address - Phone:317-887-2610
Mailing Address - Fax:317-887-2636
Practice Address - Street 1:8233 RAILROAD RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46217-4576
Practice Address - Country:US
Practice Address - Phone:317-887-2610
Practice Address - Fax:317-887-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001532A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care