Provider Demographics
NPI:1386618379
Name:WHITAKER, ANN E (PA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2121
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:3480 WAKE FOREST RD
Practice Address - Street 2:SUITE 500
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7376
Practice Address - Country:US
Practice Address - Phone:919-862-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103102363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0656817OtherUNITED HEALTHCARE
NC79535OtherBLUE CROSS BLUE SHEILD NC
NCA5441OtherMEDCOST
NC970017587OtherRAILROAD MEDICARE
NC8979535Medicaid
NC8979535Medicaid
NCP18022Medicare UPIN