Provider Demographics
NPI:1316445752
Name:RUESCHHOFF, SARA CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:CHRISTINE
Last Name:RUESCHHOFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:C
Other - Last Name:SIMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:550 UNIVERSITY BLVD STE 6100
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-948-0730
Mailing Address - Fax:317-944-4319
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5187
Practice Address - Country:US
Practice Address - Phone:317-948-0730
Practice Address - Fax:317-944-4319
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007698A363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001149228OtherANTHEM PTAN
INP02086081OtherRAILROAD PTAN
IN300010843Medicaid
IN000001286895OtherANTHEM PTAN