Provider Demographics
NPI:1396356135
Name:WHITACRE, DESIREE L (RN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:L
Last Name:WHITACRE
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 1:2055 OLD COLUMBUS RD
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-8608
Mailing Address - Country:US
Mailing Address - Phone:161-498-9306
Mailing Address - Fax:
Practice Address - Street 1:270 KENY BLVD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9040
Practice Address - Country:US
Practice Address - Phone:740-852-5701
Practice Address - Fax:740-845-1279
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.277049163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool