Provider Demographics
NPI:1669455424
Name:MCMULLEN, SUE E (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:E
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 N BUCKEYE ST
Practice Address - Street 2:
Practice Address - City:OSGOOD
Practice Address - State:IN
Practice Address - Zip Code:47037-1134
Practice Address - Country:US
Practice Address - Phone:812-689-3424
Practice Address - Fax:812-933-5237
Is Sole Proprietor?:No
Enumeration Date:2005-11-26
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001839A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200502850Medicaid
Q31667Medicare UPIN
IN255510MMedicare PIN
IN178730RMedicare PIN