Provider Demographics
NPI:1861372849
Name:WHITEHEAD, MIA (CMA)
Entity type:Individual
Prefix:MRS
First Name:MIA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 GARFIELD ST UNIT 1162
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-0708
Mailing Address - Country:US
Mailing Address - Phone:312-600-8413
Mailing Address - Fax:
Practice Address - Street 1:1116 GARFIELD ST UNIT 1162
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60304-0708
Practice Address - Country:US
Practice Address - Phone:312-600-8413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-02
Last Update Date:2025-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula