Healthcare Provider Details

I. General information

NPI: 1801984224
Provider Name (Legal Business Name): SHAWN L BOURKE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7120 CLEARVISTA DR SUITE 4000
INDIANAPOLIS IN
46256-1621
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-577-7444
  • Fax: 317-577-7433
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71001672A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: