Provider Demographics
NPI:1588775571
Name:GIANNINI, THERESA LYNNE (ANP-BC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYNNE
Last Name:GIANNINI
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:L
Other - Last Name:BROWN
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 1:1801 N SENATE BLVD STE 4000
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1184
Practice Address - Country:US
Practice Address - Phone:317-962-0500
Practice Address - Fax:317-962-0501
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001965A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01214693OtherRR MEDICARE PTAN
IN200842890AMedicaid
000000491503OtherBCBS PIN
P00351800OtherRAILROAD MEDICARE PIN
000000491503OtherBCBS PIN
Q54952Medicare UPIN
P00351800OtherRAILROAD MEDICARE PIN
INP01214693OtherRR MEDICARE PTAN
IN200842890AMedicaid