1699826073 NPI number — BETH WHITEFORD CRNP

Table of content: BETH WHITEFORD CRNP (NPI 1699826073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699826073 NPI number — BETH WHITEFORD CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITEFORD
Provider First Name:
BETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

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:
1699826073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1909 WINDROW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARRIOTTSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21104-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-549-3978
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6085 MARSHALEE DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
ELKRIDGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-379-3500
Provider Business Practice Location Address Fax Number:
410-379-3591
Provider Enumeration Date:
01/14/2007

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: 363LA2200X , with the licence number:  RO84191 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X , with the licence number: RO84191 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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