Provider Demographics
NPI:1063084507
Name:WHITTED, DOVIE MAE
Entity type:Individual
Prefix:
First Name:DOVIE
Middle Name:MAE
Last Name:WHITTED
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 1:120 HUDSON AVE APT 1A4
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2137
Mailing Address - Country:US
Mailing Address - Phone:845-518-9022
Mailing Address - Fax:
Practice Address - Street 1:120 HUDSON AVE APT 1A4
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2137
Practice Address - Country:US
Practice Address - Phone:845-518-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver