Provider Demographics
NPI:1043712508
Name:WHITLATCH, DOUGLAS J
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:J
Last Name:WHITLATCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815WILDLANEDR.
Mailing Address - Street 2:
Mailing Address - City:SOUTHCHARLESTON
Mailing Address - State:OH
Mailing Address - Zip Code:45368
Mailing Address - Country:US
Mailing Address - Phone:937-568-3136
Mailing Address - Fax:
Practice Address - Street 1:8815WILDLANEDR.
Practice Address - Street 2:
Practice Address - City:SOUTHCHARLESTON
Practice Address - State:OH
Practice Address - Zip Code:45368
Practice Address - Country:US
Practice Address - Phone:937-568-3136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care