Healthcare Provider Details

I. General information

NPI: 1013585645
Provider Name (Legal Business Name): ELINDA WHITAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10330 N LAUREL BRANCH DR
HOUSTON TX
77064-4288
US

IV. Provider business mailing address

10330 N LAUREL BRANCH DR
HOUSTON TX
77064-4288
US

V. Phone/Fax

Practice location:
  • Phone: 870-413-6188
  • Fax:
Mailing address:
  • Phone: 870-413-6188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR109473
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: