Provider Demographics
NPI:1578923124
Name:WHITAKER, DORIONNE (CNP)
Entity Type:Individual
Prefix:MS
First Name:DORIONNE
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-1204
Mailing Address - Country:US
Mailing Address - Phone:513-524-5490
Mailing Address - Fax:513-524-5101
Practice Address - Street 1:110 N POPLAR ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-1204
Practice Address - Country:US
Practice Address - Phone:513-524-5490
Practice Address - Fax:513-524-5101
Is Sole Proprietor?:No
Enumeration Date:2016-02-24
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.19033-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH20-2305158Medicaid