Individual
SHANA MARIE HENNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8111 S EMERSON AVE, INDIANAPOLIS, IN 46237-8601
(317) 528-5000
Mailing address
450 E 96TH ST STE 200, INDIANAPOLIS, IN 46240-3797
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01066872A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000618153
ANTHEM
IN
05
—
200950780
—
IN
01
—
P00748076
RAILROAD MEDICARE
IN
Enumeration date
01/04/2007
Last updated
03/17/2021
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