Provider Demographics
NPI:1104089846
Name:WHITED, MARY MICHELLE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MICHELLE
Last Name:WHITED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:MICHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9963 COSS RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-6625
Mailing Address - Country:US
Mailing Address - Phone:937-764-1321
Mailing Address - Fax:
Practice Address - Street 1:9963 COSS RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-6625
Practice Address - Country:US
Practice Address - Phone:937-764-1321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN. 338442163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse