Healthcare Provider Details

I. General information

NPI: 1114367299
Provider Name (Legal Business Name): LYNN S WHITTAKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 WELLNESS WAY SHANER CANCER CENTER
STATE COLLEGE PA
16803-6709
US

IV. Provider business mailing address

155 WELLNESS WAY SHANER CANCER CENTER
STATE COLLEGE PA
16803-6709
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-7800
  • Fax: 814-231-7295
Mailing address:
  • Phone: 814-231-7800
  • Fax: 814-231-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP012934
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: