Individual
MRS. ALICIA R WHITWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
330 N STATE ST, SUITE C, DESLOGE, MO 63601-3052
(573) 431-2829
(573) 431-7186
Mailing address
835 RIDGEVIEW DR, BONNE TERRE, MO 63628-4002
(573) 358-0801
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
145117
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
421474909
—
MO
Enumeration date
11/02/2006
Last updated
02/27/2013
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