Provider Demographics
NPI:1871047498
Name:WHITEHEAD, SHEILA I
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:WHITEHEAD
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 IOWA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-7428
Mailing Address - Country:US
Mailing Address - Phone:951-384-4699
Mailing Address - Fax:
Practice Address - Street 1:2020 IOWA AVE STE 101
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-7428
Practice Address - Country:US
Practice Address - Phone:951-384-4699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290746164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse