Healthcare Provider Details

I. General information

NPI: 1316600059
Provider Name (Legal Business Name): SIERRA WOODS MSN,RN,PMHNP-C,IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2021
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5119 PRIMROSE AVE
INDIANAPOLIS IN
46205-1310
US

IV. Provider business mailing address

5119 PRIMROSE AVE
INDIANAPOLIS IN
46205-1310
US

V. Phone/Fax

Practice location:
  • Phone: 317-260-0166
  • Fax:
Mailing address:
  • Phone: 317-260-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number28256016A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number28256016A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: