Provider Demographics
NPI:1811861685
Name:WHITAKER, ALICIA MAE (STNA)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:MAE
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4643 WAYNE MEADOWS CIR
Mailing Address - Street 2:
Mailing Address - City:HUBER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:45424-5539
Mailing Address - Country:US
Mailing Address - Phone:937-814-3268
Mailing Address - Fax:
Practice Address - Street 1:4643 WAYNE MEADOWS CIR
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-5539
Practice Address - Country:US
Practice Address - Phone:937-814-3268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH372600000X, 3747P1801X, 374U00000X
OH400534440906376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH400534440906OtherNURSEAIDEREGISTRYNUMBER