Healthcare Provider Details

I. General information

NPI: 1306482617
Provider Name (Legal Business Name): WHITNEY O'SULLIVAN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MACARTHUR BLVD
MUNSTER IN
46321-2901
US

IV. Provider business mailing address

901 MACARTHUR BLVD
MUNSTER IN
46321-2901
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-4512
  • Fax: 219-836-7386
Mailing address:
  • Phone: 219-836-4512
  • Fax: 219-836-7386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28255105A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009689A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: