Healthcare Provider Details

I. General information

NPI: 1164658530
Provider Name (Legal Business Name): LISA MARRIE WHITMAN RN, WCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2009
Last Update Date: 05/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 BENMONT AVE SUITE 17
BENNINGTON VT
05201-1873
US

IV. Provider business mailing address

13 HILLSIDE ST PO BOX 48
NORTH BENNINGTON VT
05257-9521
US

V. Phone/Fax

Practice location:
  • Phone: 802-447-4569
  • Fax:
Mailing address:
  • Phone: 802-447-2653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number0260024128
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number5080710
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: