Provider Demographics
NPI:1033561519
Name:WHITMORE, LOAN D (NP)
Entity Type:Individual
Prefix:MRS
First Name:LOAN
Middle Name:D
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:WHITMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:4892 N STONE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5761
Mailing Address - Country:US
Mailing Address - Phone:520-396-1360
Mailing Address - Fax:520-795-9043
Practice Address - Street 1:4892 N STONE AVE STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-5761
Practice Address - Country:US
Practice Address - Phone:520-396-1360
Practice Address - Fax:520-795-9043
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-07
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8728363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily