Provider Demographics
NPI:1437881919
Name:WHITESIDE, CARMEEN YVETTE
Entity Type:Individual
Prefix:
First Name:CARMEEN
Middle Name:YVETTE
Last Name:WHITESIDE
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 1:10856 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-6518
Mailing Address - Country:US
Mailing Address - Phone:317-250-0593
Mailing Address - Fax:
Practice Address - Street 1:10856 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-6518
Practice Address - Country:US
Practice Address - Phone:317-250-0593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider