Provider Demographics
NPI:1548376411
Name:WHITLOCK, ANITA K (LPN)
Entity type:Individual
Prefix:MS
First Name:ANITA
Middle Name:K
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5091 HYDE RD
Mailing Address - Street 2:.
Mailing Address - City:ROME
Mailing Address - State:OH
Mailing Address - Zip Code:44085-9633
Mailing Address - Country:US
Mailing Address - Phone:440-474-4465
Mailing Address - Fax:440-474-4465
Practice Address - Street 1:5091 HYDE RD
Practice Address - Street 2:.
Practice Address - City:ROME
Practice Address - State:OH
Practice Address - Zip Code:44085-9633
Practice Address - Country:US
Practice Address - Phone:440-474-4465
Practice Address - Fax:440-474-4465
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 069286164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN 069286OtherNURSING LICENSE
OH2278119Medicaid