Provider Demographics
NPI:1689091100
Name:APPLEWHITE, WILLIE
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:
Last Name:APPLEWHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15516 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-4319
Mailing Address - Country:US
Mailing Address - Phone:708-654-3891
Mailing Address - Fax:
Practice Address - Street 1:15516 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4319
Practice Address - Country:US
Practice Address - Phone:708-654-3891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker