Healthcare Provider Details

I. General information

NPI: 1619889987
Provider Name (Legal Business Name): EMMA LYNN SHOEMAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 N UNIVERSITY ST
WEST LAFAYETTE IN
47907-2069
US

IV. Provider business mailing address

6225 W 400 S
RUSSIAVILLE IN
46979-9704
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-4600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28289374A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: