Individual
LAUREN MARIE LILLY RADERSTORF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
996 S STATE ROAD 135, GREENWOOD, IN 46143-7365
(317) 893-3888
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002106A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300011471
—
IN
Enumeration date
09/12/2016
Last updated
02/13/2025
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