Healthcare Provider Details

I. General information

NPI: 1528940954
Provider Name (Legal Business Name): SYDNEE GUTHRIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2025
Last Update Date: 07/25/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E 3RD ST
BLOOMINGTON IN
47405-7005
US

IV. Provider business mailing address

3063 S ROGERS ST UNIT 206
BLOOMINGTON IN
47403-4462
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-5252
  • Fax:
Mailing address:
  • Phone: 812-657-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: