Provider Demographics
NPI:1366226524
Name:WHITAKER, CARRIE J (RN, PHN, MPH)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:J
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:RN, PHN, MPH
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:J
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, PHN, MPH
Mailing Address - Street 1:2222 BANCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4301
Mailing Address - Country:US
Mailing Address - Phone:510-642-2000
Mailing Address - Fax:510-643-2997
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4301
Practice Address - Country:US
Practice Address - Phone:510-642-2000
Practice Address - Fax:510-643-2997
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care