Healthcare Provider Details

I. General information

NPI: 1548094618
Provider Name (Legal Business Name): TANITA WHITNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LANDERBROOK DR STE 301
MAYFIELD HEIGHTS OH
44124-4020
US

IV. Provider business mailing address

5900 LANDERBROOK DR STE 301
MAYFIELD HEIGHTS OH
44124-4020
US

V. Phone/Fax

Practice location:
  • Phone: 216-417-8813
  • Fax:
Mailing address:
  • Phone: 216-417-8813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2613774
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: