Individual
SANDRA S STAEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7979 N SHADELAND AVE, STE 200, INDIANAPOLIS, IN 46250-2042
(317) 621-4300
(317) 621-4301
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71004456A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000825349
ANTHEM
IN
05
—
201172810
—
IN
01
—
4977520
AETNA
IN
01
—
P01293583
MEDICARE RR
IN
01
—
P01751326
RR MEDICARE
IN
Enumeration date
06/14/2013
Last updated
11/27/2023
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