Provider Demographics
NPI:1538353073
Name:WRIGHT MAST, MICHELLE E (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:E
Last Name:WRIGHT MAST
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:E
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11911 N MERIDIAN ST STE 170
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6928
Practice Address - Country:US
Practice Address - Phone:317-621-0790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH11479363LF0000X
IN71000690A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000709117OtherANTHEM
IN200454260Medicaid
IN558430131Medicare PIN
INM400036276Medicare PIN
IN200454260Medicaid