Healthcare Provider Details

I. General information

NPI: 1811389182
Provider Name (Legal Business Name): ANNA EDENS-SZESZYCKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNA EDENS-SZESZYCKI CHW/CRS

II. Dates (important events)

Enumeration Date: 02/24/2015
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 N MERIDIAN ST SUITE 102
INDIANAPOLIS IN
46202-1491
US

IV. Provider business mailing address

2105 N MERIDIAN ST SUITE 102
INDIANAPOLIS IN
46202-1491
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-5463
  • Fax: 317-956-5498
Mailing address:
  • Phone: 317-926-5463
  • Fax: 317-926-5498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1681-0-ASO
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: