Provider Demographics
NPI:1790382695
Name:WHITMAN DREWES, LINDSAY NICHOLE
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:NICHOLE
Last Name:WHITMAN DREWES
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 1:232 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1407
Mailing Address - Country:US
Mailing Address - Phone:937-453-3489
Mailing Address - Fax:
Practice Address - Street 1:232 BIRCH ST
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-1407
Practice Address - Country:US
Practice Address - Phone:937-453-3489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X, 251X00000X, 3747P1801X, 376J00000X
OH2695712172A00000X, 347C00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No251X00000XAgenciesSupports Brokerage
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0393148Medicaid