Individual
SUZANN MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSFA
Contact information
Practice address
355 W 16TH ST, SUITE 5100, INDIANAPOLIS, IN 46202-2207
(317) 393-1300
(317) 924-8472
Mailing address
8333 NAAB RD, STE 250, INDIANAPOLIS, IN 46260-5924
(317) 393-1300
(317) 396-1346
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
—
—
246ZS0410X
Surgical Technologist
Primary
83030
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000592199
ANTHEM BLUE CROSS AND BLUE SHIELD
IN
01
—
83030
CST/CFA
IN
Enumeration date
08/11/2006
Last updated
06/06/2019
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