Provider Demographics
NPI:1720458227
Name:WESSELL, TRUDY (NP)
Entity Type:Individual
Prefix:
First Name:TRUDY
Middle Name:
Last Name:WESSELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 STATE ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-8558
Mailing Address - Country:US
Mailing Address - Phone:812-254-4650
Mailing Address - Fax:
Practice Address - Street 1:2005 STATE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-8558
Practice Address - Country:US
Practice Address - Phone:812-254-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005826A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN258190069OtherMEDICARE
IN201324440Medicaid
IN000000966701OtherANTHEM