MEDICARE: SHARON ANISE SMITH APRN

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	363LA2200X	Adult Health Nurse Practitioner	APRN11038858	FL
2	163WG0000X	General Practice Registered Nurse	28251057A	IN
3	363LW0102X	Women's Health Nurse Practitioner	71013963A	IN
4	363LF0000X	Family Nurse Practitioner	71013963A	IN

General Provider Information

NPI Number	:	1790477628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON ANISE SMITH APRN

Provider Business Mailing Address
First Line	:	209 E 86TH CT STE D
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6259
Country	:	US
Telephone Number	:	219-242-7822
Fax Number	:	219-803-1404

Provider Business Practice Location Address
First Line	:	209 E 86TH CT STE D
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-6259
Country	:	US
Telephone Number	:	219-242-7822
Fax Number	:	219-803-1404

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

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	09/14/2025

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Directions to “ SHARON ANISE SMITH APRN” Practice Location

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