Healthcare Provider Details

I. General information

NPI: 1316445752
Provider Name (Legal Business Name): SARA CHRISTINE RUESCHHOFF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARA C SIMS

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5187
US

IV. Provider business mailing address

550 UNIVERSITY BLVD STE 6100
INDIANAPOLIS IN
46202-5149
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-0730
  • Fax: 317-944-4319
Mailing address:
  • Phone: 317-948-0730
  • Fax: 317-944-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71007698A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71007698A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: