Provider Demographics
NPI:1154653970
Name:WHITESIDE, JAMAICA MARIE (LPN)
Entity type:Individual
Prefix:
First Name:JAMAICA
Middle Name:MARIE
Last Name:WHITESIDE
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 1:477 MILL ST
Mailing Address - Street 2:
Mailing Address - City:SABINA
Mailing Address - State:OH
Mailing Address - Zip Code:45169-1204
Mailing Address - Country:US
Mailing Address - Phone:740-572-7525
Mailing Address - Fax:
Practice Address - Street 1:477 MILL ST
Practice Address - Street 2:
Practice Address - City:SABINA
Practice Address - State:OH
Practice Address - Zip Code:45169-1204
Practice Address - Country:US
Practice Address - Phone:740-572-7525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2024-10-31
Deactivation Date:2024-10-09
Deactivation Code:
Reactivation Date:2024-10-22
Provider Licenses
StateLicense IDTaxonomies
OHPN113142164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse