Provider Demographics
NPI:1770359580
Name:WHITED, MARY L
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:WHITED
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 1:6753 RIVERSIDE GLEN CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3638
Mailing Address - Country:US
Mailing Address - Phone:614-598-9504
Mailing Address - Fax:
Practice Address - Street 1:6753 RIVERSIDE GLEN CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3638
Practice Address - Country:US
Practice Address - Phone:614-598-9504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty