MEDICARE: DANIELLE RENEE SWEENEY FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71014418A	IN

General Provider Information

NPI Number	:	1356121131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE RENEE SWEENEY FNP-C

Provider Business Mailing Address
First Line	:	2091 BANBURRY PL
Second Line	:
City	:	AVON
State	:	IN
Zip	:	46123-6511
Country	:	US
Telephone Number	:	847-502-1577
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 DEPAUW BLVD STE 2082
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-1137
Country	:	US
Telephone Number	:	317-536-4040
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2023
Last Update Date	:	02/08/2024

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