MEDICARE: MS. ANITA K. WHITLOCK LPN

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	164W00000X	Licensed Practical Nurse	PN 069286	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PN 069286	OTHER	OH	NURSING LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548376411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA K. WHITLOCK LPN

Provider Business Mailing Address
First Line	:	5091 HYDE RD
Second Line	:	.
City	:	ROME
State	:	OH
Zip	:	44085-9633
Country	:	US
Telephone Number	:	440-474-4465
Fax Number	:	440-474-4465

Provider Business Practice Location Address
First Line	:	5091 HYDE RD
Second Line	:	.
City	:	ROME
State	:	OH
Zip	:	44085-9633
Country	:	US
Telephone Number	:	440-474-4465
Fax Number	:	440-474-4465

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/09/2007

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