Active NPI
Dolores Ann Phillips
- Nurse Practitioner
- Merrillville, IN
National Provider Identifier
1811026909
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 28053858A
- Practice address
- 5800 Broadway
Suites a-J
Merrillville, IN 46410-2601 - Phone
- (219) 884-9180
- Fax
- (219) 884-9280
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 28053858A | IN | Primary |
Addresses
Primary practice location
5800 Broadway
Suites a-J
Merrillville, IN 46410-2601
Mailing address
6306 Waite St
Merrillville, IN 46410-2854
Phone (219) 884-1455
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28053858A | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173052800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295395200000",
"number": "1811026909",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6306 WAITE ST",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464102854",
"telephone_number": "219-884-1455"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5800 BROADWAY",
"address_2": "SUITES A-J",
"city": "MERRILLVILLE",
"state": "IN",
"postal_code": "464102601",
"telephone_number": "219-884-9180",
"fax_number": "219-884-9280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "DOLORES",
"middle_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-05",
"last_updated": "2011-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "28053858A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Merrillville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.