Individual
SHANNON L CHILDERS-PAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
1701 N SENATE BLVD # A5231, INDIANAPOLIS, IN 46202-1239
(317) 962-1429
Mailing address
461 TOWN CENTER ST N, MOORESVILLE, IN 46158-2316
(317) 497-6700
(317) 497-6711
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
71003354A
IN
364SA2100X
Acute Care Clinical Nurse Specialist
Primary
28123065A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200996380
—
IN
Enumeration date
08/20/2010
Last updated
04/29/2019
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