Provider Demographics
NPI:1902043755
Name:WHITTAKER, STEPHANIE C (CNS)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:C
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:C
Other - Last Name:BOBBITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:ROOM 2001
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-9981
Practice Address - Fax:317-944-0282
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002852364S00000X
IN71002852A364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000599654OtherANTHEM
INP00926488OtherRAILROAD MEDICARE
IN000000599654OtherANTHEM
IN267030RRRMedicare PIN