Healthcare Provider Details

I. General information

NPI: 1528350857
Provider Name (Legal Business Name): MISTY SCHAF R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY PENNINGTON R.N.

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

1362 PR DEER RUN DR W
SHELBYVILLE IN
46176-8534
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28148756A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: