Provider Demographics
NPI:1043681406
Name:WELLIN, BRYCE
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:WELLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 E 61ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4668
Mailing Address - Country:US
Mailing Address - Phone:317-374-9121
Mailing Address - Fax:
Practice Address - Street 1:4145 E 61ST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4668
Practice Address - Country:US
Practice Address - Phone:317-374-9121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program