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General NPI Number Information
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NPI Number | 1700336799
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Entity Type | Individual
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Provider Name | UMPARRYS LYNNE' WITHERSPOON DNP, RN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 3800 SAINT MARY RD STE 102
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City | VALPARAISO
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State | IN
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Zip | 46383-3986
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Country | US
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Telephone | 219-286-3707
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Fax | 219-286-3708
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Provider Business Mailing Address
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Address Line | 6554 TIMBERWOOD AVE
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City | PORTAGE
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State | IN
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Zip | 46368-7240
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Country | US
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Telephone | 219-746-1152
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 28156911A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71006684A
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License Number State | IN
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