Provider Demographics
NPI:1245586718
Name:RUEDLINGER, SONYA KAY (MSN, FNP-C, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:KAY
Last Name:RUEDLINGER
Suffix:
Gender:F
Credentials:MSN, FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 WATERFRONT PARKWAY EAST DR STE 370
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-2069
Mailing Address - Country:US
Mailing Address - Phone:317-978-0257
Mailing Address - Fax:317-974-9077
Practice Address - Street 1:2611 WATERFRONT PARKWAY EAST DR STE 370
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-2069
Practice Address - Country:US
Practice Address - Phone:317-978-0257
Practice Address - Fax:317-974-9077
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28144086A363LA2200X
IN71004057A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201085750Medicaid
IN201085750Medicaid