Individual
MRS. SUZAN DENISE SPIVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1400 N RITTER AVE, STE 520, INDIANAPOLIS, IN 46219-3052
(317) 355-1234
(317) 355-1505
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71000878A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200280400
—
IN
01
—
71000878A
STATE LICENSE NUMBER
IN
01
—
P01209645
RR MEDICARE PTAN
IN
Enumeration date
04/20/2007
Last updated
03/07/2023
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