Basic Information
Provider Information
NPI: 1578181756
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WHITSETT
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 25500 POINT LOOKOUT RD
Address2:  
City: LEONARDTOWN
State: MD
PostalCode: 206502015
CountryCode: US
TelephoneNumber: 3014756019
FaxNumber: 3014756143
Practice Location
Address1: 25500 POINT LOOKOUT RD
Address2:  
City: LEONARDTOWN
State: MD
PostalCode: 206502015
CountryCode: US
TelephoneNumber: 3014756019
FaxNumber: 3014756143
Other Information
ProviderEnumerationDate: 07/14/2020
LastUpdateDate: 07/14/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/14/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174H00000X  Y Other Service ProvidersHealth Educator 

No ID Information.


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