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General NPI Number Information
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NPI Number | 1457021503
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Entity Type | Individual
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Provider Name | SHANNON FISH
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Gender | Female
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Dates
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Enumeration Date | 09/20/2021
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 3000 S STATE ROAD 135 STE 310
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City | GREENWOOD
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State | IN
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Zip | 46143-5527
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Country | US
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Telephone | 317-497-2400
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Fax | 317-497-2516
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Provider Business Mailing Address
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Address Line | 770 PINE LAKE DR
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City | GREENWOOD
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State | IN
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Zip | 46143-7512
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71011596A
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License Number State | IN
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