Provider Demographics
NPI:1043345192
Name:WHITMIRE, PAULA JEAN (LVN)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:JEAN
Last Name:WHITMIRE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 N SANTA FE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704-4045
Mailing Address - Country:US
Mailing Address - Phone:559-270-0041
Mailing Address - Fax:
Practice Address - Street 1:594 W MUNCIE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8350
Practice Address - Country:US
Practice Address - Phone:559-325-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN158308164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse