Healthcare Provider Details

I. General information

NPI: 1346237153
Provider Name (Legal Business Name): BARBARA D WHITAKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 GARFIELD AVE
PARKERSBURG WV
26101-5340
US

IV. Provider business mailing address

3211 DUDLEY AVE
PARKERSBURG WV
26104-1813
US

V. Phone/Fax

Practice location:
  • Phone: 304-424-2590
  • Fax: 304-422-3924
Mailing address:
  • Phone: 304-422-3904
  • Fax: 304-422-9324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26013
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA02458
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: