Individual
SAMANTHA NINO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1801 SENATE BLVD STE 535, INDIANAPOLIS, IN 46202-1204
(804) 389-1025
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01088193A
IN
207X00000X
Orthopaedic Surgery Physician
TRN25564
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102482429
ANTHEM PTAN
IN
01
—
1102690238
ANTHEM PTAN
IN
05
—
300065079
—
IN
Enumeration date
06/29/2017
Last updated
03/05/2025
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