Provider Demographics
NPI:1932143054
Name:WHITEHAIR, MARY ANN (CRNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:WHITEHAIR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2287 S MOUNTAINEER HWY
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:WV
Mailing Address - Zip Code:26440-7171
Mailing Address - Country:US
Mailing Address - Phone:304-265-6963
Mailing Address - Fax:304-265-6961
Practice Address - Street 1:31452 VETERANS MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:TERRA ALTA
Practice Address - State:WV
Practice Address - Zip Code:26764-9715
Practice Address - Country:US
Practice Address - Phone:304-789-6964
Practice Address - Fax:304-789-2390
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV27929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD093NK824Medicare ID - Type Unspecified
MDS60633Medicare UPIN