Healthcare Provider Details

I. General information

NPI: 1861869513
Provider Name (Legal Business Name): SANDRA DUGGAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PILGRIM BLVD
HARTFORD CITY IN
47348-1382
US

IV. Provider business mailing address

1200 W WHITE RIVER BLVD RCS PROVIDER ENROLLMENT
MUNCIE IN
47303-4988
US

V. Phone/Fax

Practice location:
  • Phone: 765-348-5776
  • Fax: 765-348-3088
Mailing address:
  • Phone: 765-254-4009
  • Fax: 765-284-7813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number28192064A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005780A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: