Provider Demographics
NPI:1821627712
Name:WHITFIELD, ANTWANIESHA M
Entity Type:Individual
Prefix:
First Name:ANTWANIESHA
Middle Name:M
Last Name:WHITFIELD
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 1:6397 KINGSDALE BLVD APT 12
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3960
Mailing Address - Country:US
Mailing Address - Phone:216-317-2902
Mailing Address - Fax:
Practice Address - Street 1:6397 KINGSDALE BLVD APT 12
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3960
Practice Address - Country:US
Practice Address - Phone:216-317-2902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910854Medicaid