Provider Demographics
NPI:1598071748
Name:WHATLEY, CARMEN (RN)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 AINTREE PARK DR
Mailing Address - Street 2:APT 204
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3555
Mailing Address - Country:US
Mailing Address - Phone:216-835-1996
Mailing Address - Fax:440-683-4893
Practice Address - Street 1:899 AINTREE PARK DR
Practice Address - Street 2:APT 204
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3555
Practice Address - Country:US
Practice Address - Phone:216-835-1996
Practice Address - Fax:440-683-4893
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH346514163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management