1316215064 NPI number — CORY R WILHITE CRNP

Table of content: CORY R WILHITE CRNP (NPI 1316215064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316215064 NPI number — CORY R WILHITE CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILHITE
Provider First Name:
CORY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316215064
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 GUILLARD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSPECT
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16052-2702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-496-6757
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 ADAMS LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16051-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-368-4118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  SP011742 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SP011742 . This is a "LICENSE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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