Provider Demographics
NPI:1588150882
Name:WHETSELL, LARRY II (CNP)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:WHETSELL
Suffix:II
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 LESH ST NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44705-4376
Mailing Address - Country:US
Mailing Address - Phone:330-456-3487
Mailing Address - Fax:
Practice Address - Street 1:2223 FULTON RD NW STE 102
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3554
Practice Address - Country:US
Practice Address - Phone:330-456-3487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP023043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner