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NPI Code Detail

MEDICARE: URSULA SUE MCCORMICK CNS

MEDICARE: URSULA SUE MCCORMICK CNS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0807XChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist70000019AIN
2364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist70000019AIN
3163W00000XRegistered Nurse28114646IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000374550OTHERANTHEM
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689658874
Entity Type Code : Individual
Provider Name (Legal Business Name) : URSULA SUE MCCORMICK CNS
Provider Business Mailing Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-337-2438
Provider Business Practice Location Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number : 812-337-2438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2005
Last Update Date : 04/03/2024

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Directions to “ URSULA SUE MCCORMICK CNS” Practice Location

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