Individual
MYRANDA WHITMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
108 W MARKET ST, BLOOMINGTON, IL 61701-3918
(309) 827-5351
Mailing address
108 W MARKET ST, BLOOMINGTON, IL 61701-3918
(309) 827-5351
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209.024190
IL
Other
Enumeration date
05/02/2014
Last updated
10/13/2021
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