Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251C2600X | Cardiopulmonary | 05007836A | IN |
NPI | 1659754430 |
---|---|
Provider Name | Cori Shank |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1239 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2015 |
Last Update Date | 30/06/2015 |