Healthcare Provider Details

I. General information

NPI: 1235602335
Provider Name (Legal Business Name): SARA R REICHERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 11/27/2023
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 E COUNTY LINE RD
INDIANAPOLIS IN
46227-0963
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-7000
  • Fax:
Mailing address:
  • Phone: 317-621-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28218642A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008777A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: