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Individual
DEMETRIUS WHITEHEAD
Active
Individual
DEMETRIUS WHITEHEAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
27060564A
IN
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
21015321
IN
320700000X
Physical Disabilities Residential Treatment Facility
Primary
21015321
IN
Other
Enumeration date
01/08/2020
Last updated
02/28/2024
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