Provider Demographics
NPI:1740989532
Name:WHITT, MARY M
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:WHITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35516 MIDLAND TRL E
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:WV
Mailing Address - Zip Code:24925-9759
Mailing Address - Country:US
Mailing Address - Phone:681-369-4258
Mailing Address - Fax:
Practice Address - Street 1:35516 MIDLAND TRL E
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:WV
Practice Address - Zip Code:24925-9759
Practice Address - Country:US
Practice Address - Phone:681-369-4258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant