Provider Demographics
NPI:1730860081
Name:WHITNEY, DETORIA (NPT)
Entity type:Individual
Prefix:
First Name:DETORIA
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:NPT
Other - Prefix:
Other - First Name:DETORIA
Other - Middle Name:
Other - Last Name:LANIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 HAMMOCK LN
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-2738
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 HAMMOCK LANE
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376
Practice Address - Country:US
Practice Address - Phone:910-613-0787
Practice Address - Fax:910-613-0379
Is Sole Proprietor?:No
Enumeration Date:2023-07-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy