Provider Demographics
NPI:1861476012
Name:WHITEHOUSE, DAVID W (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:WHITEHOUSE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5214
Mailing Address - Country:US
Mailing Address - Phone:914-637-3510
Mailing Address - Fax:914-819-0061
Practice Address - Street 1:240 FOUNTAIN CT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1888
Practice Address - Country:US
Practice Address - Phone:859-278-1460
Practice Address - Fax:859-278-0115
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1373A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74408808Medicaid
KY0985306Medicare PIN