Provider Demographics
NPI:1215766175
Name:WHITAKER-CLARKE, CHRISTINE B (RN, CDCES)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:B
Last Name:WHITAKER-CLARKE
Suffix:
Gender:F
Credentials:RN, CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5758 COOLEY LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-3073
Mailing Address - Country:US
Mailing Address - Phone:855-466-3631
Mailing Address - Fax:
Practice Address - Street 1:2714 W CROWN DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-6719
Practice Address - Country:US
Practice Address - Phone:513-673-7052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47042826493163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator