Provider Demographics
NPI:1265648380
Name:WHITEHEAD, MONICA HALLMAN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:HALLMAN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:HALLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 100272
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3272
Mailing Address - Country:US
Mailing Address - Phone:803-604-0066
Mailing Address - Fax:803-604-9924
Practice Address - Street 1:338 E COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:BATESBURG-LEESVILLE
Practice Address - State:SC
Practice Address - Zip Code:29070-9285
Practice Address - Country:US
Practice Address - Phone:803-604-0066
Practice Address - Fax:803-604-9924
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN 1619363L00000X
SCAPRN 1619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner