Provider Demographics
NPI:1871517011
Name:WHITHORN, RENA (LVN)
Entity type:Individual
Prefix:MISS
First Name:RENA
Middle Name:
Last Name:WHITHORN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 KENTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-6301
Mailing Address - Country:US
Mailing Address - Phone:916-854-4552
Mailing Address - Fax:
Practice Address - Street 1:9261 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2561
Practice Address - Country:US
Practice Address - Phone:916-854-4552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN179212251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care