Provider Demographics
NPI:1649093253
Name:WHITTAKER, BERNICE CAROL (MSN-RN)
Entity type:Individual
Prefix:MS
First Name:BERNICE
Middle Name:CAROL
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:MSN-RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5104 N AVENIDA PRIMERA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-5802
Mailing Address - Country:US
Mailing Address - Phone:520-245-5487
Mailing Address - Fax:
Practice Address - Street 1:10950 N STALLARD PL STE 102
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85737-9527
Practice Address - Country:US
Practice Address - Phone:520-535-2432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-02
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN000099196163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator