Individual
BEVERLY WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
50 BROADWAY, LYNBROOK, NY 11563-2519
(516) 887-1200
Mailing address
465 NEW HWY APT C15, COPIAGUE, NY 11726-1053
(516) 242-9483
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
216016
NY
Other
Enumeration date
08/08/2013
Last updated
08/08/2013
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