Healthcare Provider Details

I. General information

NPI: 1174517783
Provider Name (Legal Business Name): SYDNEY ELIZABETH EHMKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 BROWN ST
ANDERSON IN
46016-4216
US

IV. Provider business mailing address

10445 STONEGATE DR
FISHERS IN
46040-9432
US

V. Phone/Fax

Practice location:
  • Phone: 317-574-1254
  • Fax:
Mailing address:
  • Phone: 317-410-9119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71000027
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000027A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: