Provider Demographics
NPI:1982000931
Name:WHITENECK, STREYDEN
Entity Type:Individual
Prefix:
First Name:STREYDEN
Middle Name:
Last Name:WHITENECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S MONROE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-5761
Mailing Address - Country:US
Mailing Address - Phone:405-763-8063
Mailing Address - Fax:
Practice Address - Street 1:1477 SUE CIR
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:OK
Practice Address - Zip Code:73078-8975
Practice Address - Country:US
Practice Address - Phone:405-763-8063
Practice Address - Fax:405-373-1158
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist