Healthcare Provider Details

I. General information

NPI: 1366033177
Provider Name (Legal Business Name): SARA S ABUSHARBAIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB RD STE 360
INDIANAPOLIS IN
46260-1987
US

IV. Provider business mailing address

6646 FRONT POINT DR
INDIANAPOLIS IN
46237-4482
US

V. Phone/Fax

Practice location:
  • Phone: 317-961-6396
  • Fax:
Mailing address:
  • Phone: 618-709-6441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF01210492
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71011163A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71011163A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71011163A
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011163A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: