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Brenda S. Wiley

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128

PECOS Enrollment

This provider is enrolled in PECOS as BRENDA WILEY.

Based on the most recent information from CMS, provider Brenda S. Wiley is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1801064266
Provider Type
Individual
Full Name
Wiley, Brenda S.
Credential
NP

Gender
Female
Sole Proprietor
No
Enumeration Date
2/19/2008
Last Updated
9/30/2020

Contact Information

Practice Location

7900 W Jefferson Blvd, Suite 201, Fort Wayne, IN 46804-4128

(260) 432-2297

(260) 969-7266

Mailing Location

6920 Pointe Inverness Way Ste 200, Fort Wayne, IN 46804-7934

(260) 479-3514

(260) 479-3520

Provider Taxonomies

Code	Description	License
Code 363LF0000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License 71002581A Indiana

Provider Identifiers

ID	Description	Issuer
ID 3040613	Description Medicaid	Issuer Unlisted Ohio
ID 200888290	Description Medicaid	Issuer Unlisted Indiana

Brenda S. Wiley

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Elliott, Ann Natasha

Hayes, Kalie M.

Hetrick, Brittney L

Twomey, Helen Burns

Shaffer, Julie N.

Flack, Abigail

Weiseman, Alyssa Nicole

Neumann, Kailey

Stout, Sara Mae

Ritchie, Jennifer Lynn