Provider Demographics
NPI:1790139756
Name:MEYER, WHITNEY
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:MEYER
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 1:413 S RACE ST
Mailing Address - Street 2:
Mailing Address - City:TEUTOPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62467-1263
Mailing Address - Country:US
Mailing Address - Phone:217-821-0769
Mailing Address - Fax:
Practice Address - Street 1:413 S RACE ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-1263
Practice Address - Country:US
Practice Address - Phone:217-821-0769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.010883174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist