Provider Demographics
NPI:1467731430
Name:WHITAKER, LUCILLE AMELIA (11434)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:AMELIA
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:11434
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Mailing Address - Street 1:575 PRICE ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-2553
Mailing Address - Country:US
Mailing Address - Phone:805-201-9135
Mailing Address - Fax:805-201-9134
Practice Address - Street 1:575 PRICE ST
Practice Address - Street 2:SUITE 313
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-2553
Practice Address - Country:US
Practice Address - Phone:805-201-9135
Practice Address - Fax:805-201-9134
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA348574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily