Provider Demographics
NPI:1891973269
Name:WHITFIELD, DC (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DC
Middle Name:
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:D.C.
Other - Middle Name:
Other - Last Name:WHITFIELD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 W PARK ST STE 418
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1322
Mailing Address - Country:US
Mailing Address - Phone:802-526-2220
Mailing Address - Fax:
Practice Address - Street 1:20 W PARK ST STE 418
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:802-526-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2018-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH056284-23363LP0808X
CO122521363LP0808X
CO5404363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH056284-23OtherAPRN LICENSE NUMBER
NH46-3667192OtherEIN
NH46-3667192OtherEIN