Individual
MARY SUSAN SHICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, ANP
Contact information
Practice address
421 W 1ST ST, BLOOMINGTON, IN 47403-2403
(812) 336-0168
(812) 335-7372
Mailing address
421 W 1ST ST, BLOOMINGTON, IN 47403-2403
(812) 336-0168
(812) 335-7372
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
28090755A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71000080A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200076820A
—
IN
Enumeration date
06/28/2006
Last updated
12/21/2020
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