Healthcare Provider Details

I. General information

NPI: 1902894074
Provider Name (Legal Business Name): THOMAS HABIMANA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 GUION RD
INDIANAPOLIS IN
46222-1616
US

IV. Provider business mailing address

11460 N MERIDIAN ST STE. 110
CARMEL IN
46032-4408
US

V. Phone/Fax

Practice location:
  • Phone: 317-920-8439
  • Fax: 317-614-9655
Mailing address:
  • Phone: 317-567-2180
  • Fax: 317-614-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1097396
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28122164A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: