Individual
SHANNON C BORMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
705 RILEY HOSPITAL DR, INDIANAPOLIS, IN 46202-5109
(317) 944-4044
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
28199577A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
28199577A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001135802
ANTHEM PROVIDER NUMBER
IN
05
—
300009668
—
IN
Enumeration date
06/20/2017
Last updated
05/16/2025
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