Provider Demographics
NPI:1093359895
Name:WHITAKER, CATHERINE (MS, AGCNP-BC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:MS, AGCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ASHBURNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01430-1247
Mailing Address - Country:US
Mailing Address - Phone:978-827-5167
Mailing Address - Fax:
Practice Address - Street 1:61 MAIN ST
Practice Address - Street 2:
Practice Address - City:ASHBURNHAM
Practice Address - State:MA
Practice Address - Zip Code:01430
Practice Address - Country:US
Practice Address - Phone:978-827-5167
Practice Address - Fax:978-827-5002
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2266727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner