Provider Demographics
NPI:1912197526
Name:WHITEHURST, ANITA M (RN)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 S ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301-3402
Mailing Address - Country:US
Mailing Address - Phone:920-432-5434
Mailing Address - Fax:
Practice Address - Street 1:617 S ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3402
Practice Address - Country:US
Practice Address - Phone:920-432-5434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI109693163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse