MEDICARE: PATRICE MARIE WHITAKER APRN-BC

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	363LF0000X	Family Nurse Practitioner	4704091770	MI

General Provider Information

NPI Number	:	1548262983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICE MARIE WHITAKER APRN-BC

Provider Business Mailing Address
First Line	:	100 MICHIGAN ST NE
Second Line	:	MC 845
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:	616-486-6702
Fax Number	:	616-486-6790

Provider Business Practice Location Address
First Line	:	7751 BYRON CENTER AVE SW
Second Line	:	SUITE C
City	:	BYRON CENTER
State	:	MI
Zip	:	49315-8001
Country	:	US
Telephone Number	:	616-267-7668
Fax Number	:

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

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	06/04/2013

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