Provider Demographics
NPI:1326341504
Name:WHITT, TIWANNA D (LPN)
Entity Type:Individual
Prefix:
First Name:TIWANNA
Middle Name:D
Last Name:WHITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21003 ELLACOTT PKWY APT D9
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-4444
Mailing Address - Country:US
Mailing Address - Phone:216-744-5170
Mailing Address - Fax:
Practice Address - Street 1:21003 ELLACOTT PKWY APT D9
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-4444
Practice Address - Country:US
Practice Address - Phone:216-744-5170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135488164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse