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General NPI Number Information
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NPI Number | 1396122719
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Entity Type | Individual
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Provider Name | FOREST ANN SHERK MOTR
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Gender | Female
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 5404 GEORGETOWN RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3781
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Country | US
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Telephone | 317-291-5404
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Fax |
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Provider Business Mailing Address
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Address Line | 5870 COURTYARD CRES
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-3152
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Country | US
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Telephone | 574-261-1820
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 31004723A
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License Number State | IN
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