Healthcare Provider Details

I. General information

NPI: 1427928407
Provider Name (Legal Business Name): CHRISTINA MARIE HAISLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E VERMONT ST STE 110
INDIANAPOLIS IN
46202-3685
US

IV. Provider business mailing address

1414 CASCADES DR
GREENFIELD IN
46140-5003
US

V. Phone/Fax

Practice location:
  • Phone: 317-445-3575
  • Fax:
Mailing address:
  • Phone: 765-914-9425
  • Fax: 765-914-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number28180301A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: