Healthcare Provider Details

I. General information

NPI: 1548918394
Provider Name (Legal Business Name): LUANN RENNER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2022
Last Update Date: 03/11/2022
Certification Date: 03/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 CLEARVISTA PL STE 101
INDIANAPOLIS IN
46256-3761
US

IV. Provider business mailing address

16339 NORTHWIND CT
WESTFIELD IN
46074-7883
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1006
  • Fax: 317-621-1010
Mailing address:
  • Phone: 317-445-1433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28091966A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: