Provider Demographics
NPI:1518948140
Name:RIESNER, SHARON ANN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ANN
Last Name:RIESNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1715
Mailing Address - Country:US
Mailing Address - Phone:317-924-6351
Mailing Address - Fax:317-927-3098
Practice Address - Street 1:1650 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1715
Practice Address - Country:US
Practice Address - Phone:317-924-6351
Practice Address - Fax:317-927-3098
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001296A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN113810BBBMedicare PIN
MN232230GGGGMedicare UPIN