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General NPI Number Information
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NPI Number | 1053244871
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Entity Type | Individual
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Provider Name | OLIVIA WHITLOCK
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Gender | Female
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Dates
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Enumeration Date | 06/03/2026
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Last Update Date | 06/03/2026
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Provider Practice Location Address
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Address Line | 11109 PARKVIEW PLAZA DR
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City | FORT WAYNE
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State | IN
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Zip | 46845-1701
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Country | US
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Telephone | 260-266-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 7949 STATE ROUTE 107
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City | MONTPELIER
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State | OH
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Zip | 43543-9723
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Country | US
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Telephone | 419-799-0937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | RN.552904
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License Number State | OH
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