Provider Demographics
NPI:1144492711
Name:WHITMER, JEWELL
Entity type:Individual
Prefix:
First Name:JEWELL
Middle Name:
Last Name:WHITMER
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 1:2920 HIGHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-0010
Mailing Address - Country:US
Mailing Address - Phone:877-498-4490
Mailing Address - Fax:
Practice Address - Street 1:1110 SE CARY PKWY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-7420
Practice Address - Country:US
Practice Address - Phone:919-235-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCNM067176B00000X
VA0001178901163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
208391OtherUNITED HEALTHCARE GROUP I
NC002419079001OtherUNITED HEALTHCARE
NC7000091Medicaid
NC015PNOtherBLUE CROSS GROUP NUMBER
NC11351OtherBLUE CROSS BLUE SHIELD