Provider Demographics
NPI:1316669708
Name:WHIGHAM, ANITA
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:WHIGHAM
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:N71W13960 NICOLET CT
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-5251
Mailing Address - Country:US
Mailing Address - Phone:414-364-4634
Mailing Address - Fax:
Practice Address - Street 1:N71W13960 NICOLET CT
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-5251
Practice Address - Country:US
Practice Address - Phone:414-364-4634
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty