Provider Demographics
NPI:1194252890
Name:WHITNER, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WHITNER
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:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-0846
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:825 CLARK ST SUITE A
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440-0846
Practice Address - Country:US
Practice Address - Phone:719-836-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN140454163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse