Healthcare Provider Details

I. General information

NPI: 1023711017
Provider Name (Legal Business Name): SIERRA SIMONE ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

1040 WISHARD BLVD
INDIANAPOLIS IN
46202-2872
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-2000
  • Fax:
Mailing address:
  • Phone: 317-962-8893
  • Fax: 317-962-5479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: