MEDICARE: MRS. ELIZABETH ANN WHITEHURST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0200X	Pediatric Clinical Nurse Specialist	541879	TX

General Provider Information

NPI Number	:	1457681017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN WHITEHURST

Provider Business Mailing Address
First Line	:	3501 ARANSAS ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-1301
Country	:	US
Telephone Number	:	361-851-0848
Fax Number	:	361-851-5193

Provider Business Practice Location Address
First Line	:	3845 S PADRE ISLAND DR
Second Line	:	3533 SOUTH ALAMEDA
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-2919
Country	:	US
Telephone Number	:	361-854-4626
Fax Number	:	361-851-5193

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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