Individual
LISA MARIE WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7979 N SHADELAND AVE STE 310, INDIANAPOLIS, IN 46250-2042
(317) 621-3891
(317) 621-3893
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28185844A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71003733A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201108780
—
IN
01
—
P01824831
RR MEDICARE
IN
Enumeration date
07/06/2011
Last updated
04/14/2025
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