Healthcare Provider Details

I. General information

NPI: 1326089236
Provider Name (Legal Business Name): REBECCA S. SLOAN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2862 W 100 N
GREENFIELD IN
46140-7856
US

IV. Provider business mailing address

7366 TAPPAN DR
INDIANAPOLIS IN
46268-5708
US

V. Phone/Fax

Practice location:
  • Phone: 317-326-1221
  • Fax: 317-326-1805
Mailing address:
  • Phone: 317-328-2669
  • Fax: 317-326-2669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71000665A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: