Provider Demographics
NPI:1871891630
Name:WHITMORE, NICOLE L
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:WHITMORE
Suffix:
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 1:73 HENTON RD
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:NY
Mailing Address - Zip Code:13734-1715
Mailing Address - Country:US
Mailing Address - Phone:607-239-1031
Mailing Address - Fax:
Practice Address - Street 1:103 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3220
Practice Address - Country:US
Practice Address - Phone:607-737-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6549836124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6549836OtherLICENSE