Provider Demographics
NPI:1750029542
Name:WHITMORE, KAITLYN DANIELLE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:DANIELLE
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35640 WILLIS CT
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-2890
Mailing Address - Country:US
Mailing Address - Phone:313-942-0048
Mailing Address - Fax:
Practice Address - Street 1:35640 WILLIS CT
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2890
Practice Address - Country:US
Practice Address - Phone:313-942-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704362500163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse