Healthcare Provider Details

I. General information

NPI: 1841415569
Provider Name (Legal Business Name): PATRICIA A. WHITTLES R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 CAMPUS DR
COLLEGE PARK MD
20742-0001
US

IV. Provider business mailing address

6702 WALKER BRANCH DR
LAUREL MD
20707-3246
US

V. Phone/Fax

Practice location:
  • Phone: 301-314-8157
  • Fax: 301-405-9755
Mailing address:
  • Phone: 301-498-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License NumberR115344
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: