Healthcare Provider Details

I. General information

NPI: 1710621685
Provider Name (Legal Business Name): ANCA GEORGIANA WHITEHOUSE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

V. Phone/Fax

Practice location:
  • Phone: 256-975-2337
  • Fax:
Mailing address:
  • Phone: 256-975-2337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number1-115427
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: