Provider Demographics
NPI:1508298167
Name:WHITTAKER, MICHELLE A (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14580 224TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11413-3443
Mailing Address - Country:US
Mailing Address - Phone:609-498-9425
Mailing Address - Fax:
Practice Address - Street 1:14580 224TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11413-3443
Practice Address - Country:US
Practice Address - Phone:609-498-9425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3134291164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse