Individual
LACONNA MARYE WHITTAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
750 OLD HICKORY BLVD BLDG 1, SUITE 190, BRENTWOOD, TN 37027-4528
(615) 661-7594
Mailing address
432 CARL MILLER DR, ANTIOCH, TN 37013-4408
(615) 750-3880
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN0000052463
TN
Other
Enumeration date
10/07/2010
Last updated
10/07/2010
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