Provider Demographics
NPI:1720041494
Name:WHITAKER, ANITA (NP)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4593
Mailing Address - Country:US
Mailing Address - Phone:209-558-7248
Mailing Address - Fax:
Practice Address - Street 1:2412 3RD STREET
Practice Address - Street 2:
Practice Address - City:HUGHSON
Practice Address - State:CA
Practice Address - Zip Code:95326
Practice Address - Country:US
Practice Address - Phone:209-558-7250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP2398363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN360549OtherMEDICAL
P18176Medicare UPIN