Healthcare Provider Details

I. General information

NPI: 1124262191
Provider Name (Legal Business Name): DANEEN WHITSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 TONGASS DR
SITKA AK
99835-9416
US

IV. Provider business mailing address

222 TONGASS DR
SITKA AK
99835-9416
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-8331
  • Fax: 907-966-8830
Mailing address:
  • Phone: 907-966-8331
  • Fax: 907-966-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number8350
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: