Healthcare Provider Details

I. General information

NPI: 1235895889
Provider Name (Legal Business Name): SARAH AEAVENLY BRUNO FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 06/28/2022
Certification Date: 06/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 PARKDALE PL
INDIANAPOLIS IN
46254-5620
US

IV. Provider business mailing address

6620 PARKDALE PL
INDIANAPOLIS IN
46254-5620
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71011848A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011848A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: