Healthcare Provider Details

I. General information

NPI: 1396668844
Provider Name (Legal Business Name): EMMA SIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16201 N COUNTY LINE RD
SUNMAN IN
47041-8901
US

IV. Provider business mailing address

16201 N COUNTY LINE RD
SUNMAN IN
47041-8901
US

V. Phone/Fax

Practice location:
  • Phone: 812-363-2413
  • Fax:
Mailing address:
  • Phone: 812-363-2413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28258660A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0043297
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: