Provider Demographics
NPI:1346677416
Name:WHITTAKER, DORA (RN)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 411
Mailing Address - Street 2:165 MONN VALLEY RD
Mailing Address - City:QUILCENE
Mailing Address - State:WA
Mailing Address - Zip Code:98376-0411
Mailing Address - Country:US
Mailing Address - Phone:360-301-0478
Mailing Address - Fax:360-765-3241
Practice Address - Street 1:170 MOON VALLEY DR
Practice Address - Street 2:
Practice Address - City:QUILCENE
Practice Address - State:WA
Practice Address - Zip Code:98376-0411
Practice Address - Country:US
Practice Address - Phone:360-301-0478
Practice Address - Fax:360-765-3241
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00058765163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse