Organization · Type 2 NPI

Privia Medical Group Indiana, LLC

Family Nurse Practitioner · Wakarusa, IN

NPI number 1568147809 Active

Practice location

100 N. Elkhart St
Wakarusa, IN 46573

Call (574) 296-3200 Map

Mailing address

PO Box 778985
Chicago, IL 60677-8985

Specialties and licenses

Taxonomy	Code	License
Family Nurse Practitioner Primary	363LF0000X	None listed

Family Nurse Practitioner: Definition to come...

Other family nurse practitioner providers in Wakarusa

Wakarusa Wellness Clinic LLCFamily Nurse Practitioner Wakarusa, IN NPI 1528786753

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NPI record

NPI: 1568147809
Entity type: Organization (Type 2)
Issued: Jun 15, 2023
Last updated: May 12, 2025
Status: Active
Subpart: Yes of Elkhart Clinic, LLC

Other names

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Elkhart Clinic Wakarusa · other name
Elkhart Clinic Wakarusa · other name

Authorized official

Megan Leigh Carlson
Provider Enrollment
(574) 296-3991

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1568147809

Privia Medical Group Indiana, LLC's National Provider Identifier is 1568147809, issued on Jun 15, 2023. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Wakarusa, IN. The record was last updated on May 12, 2025.