Starr Bacon
Individual provider Active NPI Clinical Nurse Specialist · Indianapolis, IN
NPI 1558062117 · NPPES record last updated Mar 13, 2023
Key facts
- NPI
- 1558062117
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Nurse Specialist 364S00000X
- License
- 28214711A (IN)
- Practice address
- 1500 N Ritter Ave
Indianapolis, IN 46219-3027 - Phone
- (317) 355-1411
- NPI assigned
- Mar 13, 2023
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28214711A | IN | MD | Clinical Nurse Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Nurse Specialist | 364S00000X | 28214711A | IN | Yes |
Addresses
Primary practice location
1500 N Ritter Ave
Indianapolis, IN 46219-3027
Mailing address
10409 Kira CT
Indianapolis, IN 46236-7343
Phone (317) 414-1477
Other providers in Indianapolis, IN
- Sougandhi Backhaus
- Haydee Backing
- Doreen A Backus
- Benjamin Scott Bacon
- Gary Lee Bacon
- Veronica Bacon
- Bacsa Dental PC
- Tim Bacsa
- Brent Taylor Bacus
- Aashia M Bade
All providers in Indianapolis, IN · Clinical Nurse Specialist in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.