Provider Demographics
NPI:1336014141
Name:WHITEHEAD, ELIZABETH ELLEN
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ELLEN
Other - Last Name:EARL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:216 N DENVER AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-5138
Mailing Address - Country:US
Mailing Address - Phone:402-462-5107
Mailing Address - Fax:402-462-5126
Practice Address - Street 1:2536 CARLETON AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1221
Practice Address - Country:US
Practice Address - Phone:308-385-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion