Provider Demographics
NPI:1700336799
Name:WITHERSPOON, UMPARRYS LYNNE' (DNP, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:UMPARRYS
Middle Name:LYNNE'
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:DNP, RN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6554 TIMBERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-7240
Mailing Address - Country:US
Mailing Address - Phone:219-746-1152
Mailing Address - Fax:
Practice Address - Street 1:3800 SAINT MARY RD STE 102
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3986
Practice Address - Country:US
Practice Address - Phone:219-286-3707
Practice Address - Fax:219-286-3708
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28156911A363LF0000X
IN71006684A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily