Unknown Individual – Family Nurse Practitioner, NPI 1548748577

Unknown Individual is a healthcare provider. based in Plymouth, Indiana. specializing in Family Nurse Practitioner. They hold a License No. 28192906A (IN). The NPI Number for Unknown Individual is 1548748577

Main info

Organization
Inactive
8 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1548748577
Phone
Not provided
Address
11519 QUEEN RD
Deactivation Date
19 April 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
5745463830
Graduation Year
2018 (8 years ago)
PAC ID
5395096457
Group Practice PAC ID
6406126572
Professional Enrollment ID
I20180928001591
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 11519 QUEEN RD

    PLYMOUTH, IN 465638139

    Phone:

    Type: Mailing

  • 417, South Whitlock Street, Bremen, Marshall County, Indiana, 46506, United States

    BREMEN, IN 465061626

    Phone: (574) 546-0330

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 46563)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6406126572View full group profile

Reviews

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Frequently asked questions

What unique ID ties claims to Unknown Individual?
NPI 1548748577 is assigned to Unknown Individual under the national enumeration system.
What is the next step if Unknown Individual is inactive?
Treat inactive as a signal to verify Unknown Individual through official channels.
What kind of provider is Unknown Individual?
The page reflects Family Nurse Practitioner for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Plymouth, Indiana for Unknown Individual; download NPPES for the complete set.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1548748577. Always confirm identity and privileges with the practice and licensing boards.

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