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NPI Code Detail

MEDICARE: MRS. THERESA LAVON WHITTINGTON REGISTERED NURSE

MEDICARE: MRS. THERESA LAVON WHITTINGTON REGISTERED NURSE
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
1163W00000XRegistered NurseRN-144571OH

General Provider Information

NPI Number : 1629470844
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. THERESA LAVON WHITTINGTON REGISTERED NURSE
Provider Business Mailing Address
First Line : 11013 DULL ROBINSON RD
Second Line :
City : VAN WERT
State : OH
Zip : 45891-8964
Country : US
Telephone Number : 419-203-4068
Fax Number :
Provider Business Practice Location Address
First Line : 205 W CRAWFORD ST
Second Line :
City : VAN WERT
State : OH
Zip : 45891-1903
Country : US
Telephone Number : 419-238-0648
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/18/2014
Last Update Date : 09/18/2014

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