Provider Demographics
NPI:1053501536
Name:HENNING, NADINE C (NP)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:C
Last Name:HENNING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:B
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8075 N SHADELAND AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2693
Practice Address - Country:US
Practice Address - Phone:317-621-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01678727OtherMEDICARE RAILROAD PTAN
IN200880370Medicaid
IN200880370Medicaid
INP01678727OtherMEDICARE RAILROAD PTAN
INM400015032Medicare PIN