Provider Demographics
NPI:1245648989
Name:WHITEHEAD, ALICIA (LPN)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 QUAIL VALLEY CT
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-5828
Mailing Address - Country:US
Mailing Address - Phone:614-802-9110
Mailing Address - Fax:
Practice Address - Street 1:495 QUAIL VALLEY CT
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-5828
Practice Address - Country:US
Practice Address - Phone:614-802-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156155164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse