Kawajalein Latic Whitaker, FNP
Nurse Practitioner, Family in Loganville, GA. Individual provider (NPI-1).
NPI number1982132171
StatusActive
Last updated in NPPESJun 1, 2017
Details
- NPI
- 1982132171
- Entity type
- Individual (NPI-1)
- Name
- Kawajalein Latic Whitaker
- Credential
- FNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 1, 2017
- Last updated
- Jun 1, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | RN224425 | GA | Yes |
Practice location
101 Tara Commons DrLoganville, GA 30052-8018
Phone 678-928-9701
Mailing address
3531 Glen Summit LnSnellville, GA 30039-7612
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