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Individual

RANDI ANTWORTH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
7910 E WASHINGTON ST, SUITE 110, INDIANAPOLIS, IN 46219-6803
(317) 355-3201
(317) 355-3217
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
194641
NC
363LF0000X
Family Nurse Practitioner
Primary
28202147A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201133580
IN
01
P01678752
RR MEDICARE
IN
Enumeration date
07/24/2009
Last updated
11/27/2023
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