Healthcare Provider Details

I. General information

NPI: 1659181592
Provider Name (Legal Business Name): CHARISSE F SHAFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARISSE FISHER RN

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 E 136TH ST STE 2400
FISHERS IN
46037-9810
US

IV. Provider business mailing address

13100 E 136TH ST STE 2400
FISHERS IN
46037-9810
US

V. Phone/Fax

Practice location:
  • Phone: 317-678-3777
  • Fax:
Mailing address:
  • Phone: 317-678-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016010A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: