Healthcare Provider Details

I. General information

NPI: 1497868186
Provider Name (Legal Business Name): WENDY LORRAINE SHANNON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY LORRAINE SHANNON-HARDEN FNP-C

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 11/27/2023
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 E 96TH ST
FISHERS IN
46037-9795
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1290
  • Fax: 317-621-1291
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000333A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: