Provider Demographics
NPI:1487453783
Name:SMITHBURNS, JEANINE ELLEN (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:ELLEN
Last Name:SMITHBURNS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6026 BUNTON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-1307
Mailing Address - Country:US
Mailing Address - Phone:317-619-4121
Mailing Address - Fax:
Practice Address - Street 1:6026 BUNTON DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1307
Practice Address - Country:US
Practice Address - Phone:317-619-4121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28245081A163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty