Individual
GARY WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1800 E PARK AVE, STATE COLLEGE, PA 16803-6701
(814) 231-7000
Mailing address
776 TANAGER DR, STATE COLLEGE, PA 16803-2502
(814) 571-2057
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
131252
PA
Other
Enumeration date
06/29/2020
Last updated
06/29/2020
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