Healthcare Provider Details

I. General information

NPI: 1710292214
Provider Name (Legal Business Name): LEAH WHITLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MUNRO AVE
CAPE MAY NJ
08204-5000
US

IV. Provider business mailing address

1101 GEORGIA AVE
CAPE MAY COURT HOUSE NJ
08210-2751
US

V. Phone/Fax

Practice location:
  • Phone: 609-898-6368
  • Fax: 609-898-6962
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR10694600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: