Provider Demographics
NPI:1083190474
Name:WHITEHEAD, MARGARET CLAIRE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:CLAIRE
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:MS
Mailing Address - Zip Code:38868-0261
Mailing Address - Country:US
Mailing Address - Phone:901-281-8172
Mailing Address - Fax:
Practice Address - Street 1:1050 UNION UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3656
Practice Address - Country:US
Practice Address - Phone:901-281-8172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK181590367500000X
KY3012803367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered