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Individual

SHAWN L BOURKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
7120 CLEARVISTA DR, SUITE 4000, INDIANAPOLIS, IN 46256-1621
(317) 577-7444
(317) 577-7433
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805

Taxonomy

Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
71001672A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000647937
ANTHEM
IN
05
200956260
IN
Enumeration date
10/11/2006
Last updated
07/14/2015
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