Provider Demographics
NPI:1093043978
Name:WHITT, STEPHANIA (LPN)
Entity type:Individual
Prefix:
First Name:STEPHANIA
Middle Name:
Last Name:WHITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 REVERE CIR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-8521
Mailing Address - Country:US
Mailing Address - Phone:865-237-2104
Mailing Address - Fax:
Practice Address - Street 1:128 REVERE CIR
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-8521
Practice Address - Country:US
Practice Address - Phone:865-237-2104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-03
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse