Healthcare Provider Details

I. General information

NPI: 1619481546
Provider Name (Legal Business Name): CARA A. WHITTUM CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HAMPTON RD
EXETER NH
03833-4831
US

IV. Provider business mailing address

100 GILES RD
EAST KINGSTON NH
03827-2010
US

V. Phone/Fax

Practice location:
  • Phone: 603-418-6310
  • Fax:
Mailing address:
  • Phone: 603-770-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number1986
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: