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General NPI Number Information
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NPI Number | 1396903241
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Entity Type | Individual
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Provider Name | ANDREA NICOLE BANET PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 550 UNIVERSITY BLVD SUITE 1295
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5149
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Country | US
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Telephone | 317-944-9400
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Fax | 317-944-5645
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Provider Business Mailing Address
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Address Line | 250 N SHADELAND AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4959
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Country | US
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Telephone |
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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 | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 36001457A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 10002134A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10002134A
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License Number State | IN
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