Provider Demographics
NPI:1477277218
Name:WHITEHEAD, DEBBIE
Entity Type:Individual
Prefix:
First Name:DEBBIE
Middle Name:
Last Name:WHITEHEAD
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 1:15381 HIGHWAY 187
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:NM
Mailing Address - Zip Code:87942-9029
Mailing Address - Country:US
Mailing Address - Phone:575-740-1876
Mailing Address - Fax:
Practice Address - Street 1:900 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:T OR C
Practice Address - State:NM
Practice Address - Zip Code:87901-6600
Practice Address - Country:US
Practice Address - Phone:575-740-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker