Healthcare Provider Details

I. General information

NPI: 1629742960
Provider Name (Legal Business Name): SUSAN ARLENE WEBSTER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 FONTHILL DR
INDIANAPOLIS IN
46236-8629
US

IV. Provider business mailing address

11260 FONTHILL DR
INDIANAPOLIS IN
46236-8629
US

V. Phone/Fax

Practice location:
  • Phone: 317-435-6390
  • Fax:
Mailing address:
  • Phone: 317-435-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011378A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: