Provider Demographics
NPI:1699134122
Name:WHITTIER, SEVERINE M (CRNA)
Entity type:Individual
Prefix:
First Name:SEVERINE
Middle Name:M
Last Name:WHITTIER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LONDONDERRY DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7920
Mailing Address - Country:US
Mailing Address - Phone:254-776-0266
Mailing Address - Fax:542-776-2511
Practice Address - Street 1:405 LONDONDERRY DR STE 105
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7920
Practice Address - Country:US
Practice Address - Phone:254-776-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142755207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology