Provider Demographics
NPI:1578436788
Name:WHITTAKER, MICHELLE DIANE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DIANE
Last Name:WHITTAKER
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 1:10221 WOOSTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CRESTON
Mailing Address - State:OH
Mailing Address - Zip Code:44217-9527
Mailing Address - Country:US
Mailing Address - Phone:330-421-9393
Mailing Address - Fax:
Practice Address - Street 1:10221 WOOSTER PIKE
Practice Address - Street 2:
Practice Address - City:CRESTON
Practice Address - State:OH
Practice Address - Zip Code:44217-9527
Practice Address - Country:US
Practice Address - Phone:330-421-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty