MEDICARE: KAREN WHITAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	60543653	WA

General Provider Information

NPI Number	:	1306216072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN WHITAKER

Provider Business Mailing Address
First Line	:	9817 GROVE RD SE
Second Line	:
City	:	YELM
State	:	WA
Zip	:	98597-9604
Country	:	US
Telephone Number	:	360-888-4367
Fax Number	:

Provider Business Practice Location Address
First Line	:	9817 GROVE RD SE
Second Line	:
City	:	YELM
State	:	WA
Zip	:	98597-9604
Country	:	US
Telephone Number	:	360-888-4367
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2015
Last Update Date	:	10/06/2015

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