Provider Demographics
NPI:1689643538
Name:DYCUS, CREOLE MARIE (FNP, APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:CREOLE
Middle Name:MARIE
Last Name:DYCUS
Suffix:
Gender:F
Credentials:FNP, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11319 SHOREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8625
Mailing Address - Country:US
Mailing Address - Phone:317-823-1709
Mailing Address - Fax:
Practice Address - Street 1:11845 ALLISONVILLE RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2313
Practice Address - Country:US
Practice Address - Phone:317-842-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000360A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11446468OtherCAQH
INQ28561Medicare UPIN
IN115340FMedicare ID - Type Unspecified