Healthcare Provider Details

I. General information

NPI: 1255196838
Provider Name (Legal Business Name): SUSAN BRANDENBURG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSAN BAKER

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N MADISON AVE
ANDERSON IN
46011-3453
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-4242
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71014940A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014940A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: