Provider Demographics
NPI:1629689989
Name:BLACK, WHITNEY (MS, RD, LD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8169 S 185TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-6451
Mailing Address - Country:US
Mailing Address - Phone:662-322-9037
Mailing Address - Fax:
Practice Address - Street 1:8169 S 185TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-6451
Practice Address - Country:US
Practice Address - Phone:662-322-9037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114288133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered