Provider Demographics
NPI:1619981412
Name:WHITTAKER, ANGELA D (AUD)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:D
Last Name:WHITTAKER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6490 S MCCARRAN BLVD STE 29
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6124
Mailing Address - Country:US
Mailing Address - Phone:775-561-4327
Mailing Address - Fax:775-686-6160
Practice Address - Street 1:6490 S MCCARRAN BLVD STE 29
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6124
Practice Address - Country:US
Practice Address - Phone:775-561-4327
Practice Address - Fax:775-686-6160
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVA-174231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV40664Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER