Healthcare Provider Details

I. General information

NPI: 1902043755
Provider Name (Legal Business Name): STEPHANIE C WHITTAKER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE C BOBBITT

II. Dates (important events)

Enumeration Date: 01/15/2009
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR ROOM 2001
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-9981
  • Fax: 317-944-0282
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number71002852
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number71002852A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: