Provider Demographics
NPI:1356795652
Name:WILLIAM L. WHITEMAN
Entity type:Organization
Organization Name:WILLIAM L. WHITEMAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CAREGIVER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WHITEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-775-0985
Mailing Address - Street 1:7811 144TH STREET CT. E.
Mailing Address - Street 2:C/O JENNIFER BRANTLEY
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375
Mailing Address - Country:US
Mailing Address - Phone:206-775-0985
Mailing Address - Fax:
Practice Address - Street 1:7811 144TH STREET CT E
Practice Address - Street 2:C/O JENNIFER BRANTLEY
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-8404
Practice Address - Country:US
Practice Address - Phone:206-775-0985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANAR.NA.00175848311Z00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility