Individual
MRS. SHAUNA KAY SIDHOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4026 MADISON AVE, INDIANAPOLIS, IN 46227
(317) 788-0396
(317) 780-0860
Mailing address
200 SOUTH MERIDIAN STREET, SUITE 400, INDIANAPOLIS, IN 46225
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002333A
IN
363LF0000X
Family Nurse Practitioner
71002333A
IN
Other
Enumeration date
12/10/2007
Last updated
04/09/2008
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