Basic Information
Provider Information
NPI: 1073840013
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITMORE
FirstName: RACHEL
MiddleName: M.
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 401 W GREENLAWN AVE
Address2:  
City: LANSING
State: MI
PostalCode: 489102819
CountryCode: US
TelephoneNumber: 5179756000
FaxNumber:  
Practice Location
Address1: 401 W GREENLAWN AVE
Address2:  
City: LANSING
State: MI
PostalCode: 489102819
CountryCode: US
TelephoneNumber: 5179756000
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/12/2009
LastUpdateDate: 07/30/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X4704248475MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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