Provider Demographics
NPI:1104380377
Name:WHITAKER, DORIS DEJANEA
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:DEJANEA
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2406 BAHAMA POINT AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0965
Mailing Address - Country:US
Mailing Address - Phone:702-401-4023
Mailing Address - Fax:
Practice Address - Street 1:2406 BAHAMA POINT AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0965
Practice Address - Country:US
Practice Address - Phone:702-401-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant