Provider Demographics
NPI:1518719707
Name:WHITEHAIR, ANITA
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:WHITEHAIR
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 1:1338 JO HARRY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-3562
Mailing Address - Country:US
Mailing Address - Phone:304-641-6066
Mailing Address - Fax:
Practice Address - Street 1:1338 JO HARRY DR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-3562
Practice Address - Country:US
Practice Address - Phone:304-641-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV83409163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health