Provider Demographics
NPI:1033540638
Name:WHITTAKER, ALISSA (FNP)
Entity type:Individual
Prefix:
First Name:ALISSA
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 N MICHIGAN ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2132
Mailing Address - Country:US
Mailing Address - Phone:574-936-2643
Mailing Address - Fax:574-540-4001
Practice Address - Street 1:113 N MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2132
Practice Address - Country:US
Practice Address - Phone:574-936-2643
Practice Address - Fax:574-540-4001
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2025-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004885A363LF0000X
IN28186867A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ININ5586003OtherFNP
IN201222850Medicaid