Healthcare Provider Details

I. General information

NPI: 1184643462
Provider Name (Legal Business Name): CLINT WHITWER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 NORTH 13TH STREET
NORFOLK NE
68701
US

IV. Provider business mailing address

84521 534 AVE
TILDEN NE
68781-8033
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-0797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number74
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: