Provider Demographics
NPI:1053679936
Name:WHITTINGTON, MICHAEL MIRICK (NURSE)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MIRICK
Last Name:WHITTINGTON
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6555 HIGH CIR
Mailing Address - Street 2:
Mailing Address - City:MORRISON
Mailing Address - State:CO
Mailing Address - Zip Code:80465-2625
Mailing Address - Country:US
Mailing Address - Phone:303-475-9945
Mailing Address - Fax:
Practice Address - Street 1:6555 HIGH CIRCLE
Practice Address - Street 2:
Practice Address - City:MORRISON
Practice Address - State:CO
Practice Address - Zip Code:80465
Practice Address - Country:US
Practice Address - Phone:303-475-9945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO167397163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse