Provider Demographics
NPI:1982162491
Name:HIRSCHY, REAGAN E (NP)
Entity Type:Individual
Prefix:
First Name:REAGAN
Middle Name:E
Last Name:HIRSCHY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REAGAN
Other - Middle Name:E
Other - Last Name:ROSENBALM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-217-3500
Practice Address - Fax:317-217-3551
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008816A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN266430768OtherMEDICARE PTAN
IN300024040Medicaid
INQ00041524OtherRAILROAD PTAN
IN267030129OtherMEDICARE PTAN
INP02565818OtherRAILROAD PTAN