Provider Demographics
NPI:1194462242
Name:WHITTAKER, LAURA-ASHLEY
Entity Type:Individual
Prefix:
First Name:LAURA-ASHLEY
Middle Name:
Last Name:WHITTAKER
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 1:31 E MACARTHUR CRES APT B311
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-6002
Mailing Address - Country:US
Mailing Address - Phone:949-701-3199
Mailing Address - Fax:
Practice Address - Street 1:31 E MACARTHUR CRES APT B311
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-6002
Practice Address - Country:US
Practice Address - Phone:949-701-3199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program