Provider Demographics
NPI:1497561328
Name:WHITMER, STEPHANIE R
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:WHITMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ESSENTIAL CARE
Other - Middle Name:OF
Other - Last Name:AUGUSTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:42 BAILEY RD
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:VA
Mailing Address - Zip Code:24437-2067
Mailing Address - Country:US
Mailing Address - Phone:540-448-3158
Mailing Address - Fax:
Practice Address - Street 1:42 BAILEY RD
Practice Address - Street 2:
Practice Address - City:FORT DEFIANCE
Practice Address - State:VA
Practice Address - Zip Code:24437-2067
Practice Address - Country:US
Practice Address - Phone:540-448-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-05
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0173829513171M00000X
VA1497561328171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0173829513Medicaid
VA1497561328Medicaid