Provider Demographics
NPI:1497564231
Name:FIEDLER, ALI M (NP)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:M
Last Name:FIEDLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALI
Other - Middle Name:M
Other - Last Name:PETRIKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:550 UNIVERSITY BLVD # UH-1501
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:179-480-7623
Mailing Address - Fax:317-948-0503
Practice Address - Street 1:550 UNIVERSITY BLVD # UH-1501
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:179-480-7623
Practice Address - Fax:317-948-0503
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71016120A363LA2200X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300101372Medicaid