Provider Demographics
NPI:1497326649
Name:SIDHU, RINKOO (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:RINKOO
Middle Name:
Last Name:SIDHU
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 S EMERSON AVE STE I
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1914
Mailing Address - Country:US
Mailing Address - Phone:317-296-7707
Mailing Address - Fax:
Practice Address - Street 1:1311 W 96TH ST STE 110
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1172
Practice Address - Country:US
Practice Address - Phone:317-296-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71011288A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health