Provider Demographics
NPI:1275696775
Name:BERTONI, SARAH KATHLEEN (NP)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:KATHLEEN
Last Name:BERTONI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:KATHLEEN
Other - Last Name:BUCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-0860
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 635
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1212
Practice Address - Country:US
Practice Address - Phone:317-271-2800
Practice Address - Fax:317-278-1010
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28157561A163WE0003X
IN71003644A363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201099600Medicaid
IN000000844555OtherANTHEM PIN
IN233690011Medicare PIN
IN264430216Medicare PIN