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General NPI Number Information
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NPI Number | 1417014051
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Entity Type | Individual
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Provider Name | MS. CONNIE MARIE WHITENACK
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Gender | Female
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5772 DIBBLE RD APT D
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City | KINGSVILLE
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State | OH
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Zip | 44048-9802
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Country | US
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Telephone | 440-224-1987
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Fax |
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Provider Business Mailing Address
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Address Line | 880 W MORGAN RD
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City | JEFFERSON
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State | OH
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Zip | 44047-8130
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Country | US
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Telephone | 440-645-6961
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Fax | 440-998-7899
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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