Provider Demographics
NPI:1811175300
Name:GILTNER, SHANNON M (NP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:GILTNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:M
Other - Last Name:GIBBONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7150 CLEARVISTA DRIVE
Mailing Address - Street 2:NEONATAL DEPARTMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1695
Mailing Address - Country:US
Mailing Address - Phone:317-621-5621
Mailing Address - Fax:317-621-7876
Practice Address - Street 1:7150 CLEARVISTA DRIVE
Practice Address - Street 2:NEONATAL DEPARTMENT
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1695
Practice Address - Country:US
Practice Address - Phone:317-621-5621
Practice Address - Fax:317-621-7876
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002520A363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal