Individual
ANDREA NICOLE BANET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
550 UNIVERSITY BLVD, SUITE 1295, INDIANAPOLIS, IN 46202-5149
(317) 944-9400
(317) 944-5645
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
36001457A
IN
363AM0700X
Medical Physician Assistant
Primary
10002134A
IN
363AS0400X
Surgical Physician Assistant
10002134A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001083244
ANTHEM PTAN
IN
01
—
000001300672
ANTHEM PTAN
IN
05
—
300015587
—
IN
Enumeration date
05/28/2008
Last updated
02/10/2025
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