Provider Demographics
NPI:1922557768
Name:WHITELOW, NIESHA LYNETTA I
Entity type:Individual
Prefix:
First Name:NIESHA
Middle Name:LYNETTA
Last Name:WHITELOW
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 1:3555 W BULLARD AVE
Mailing Address - Street 2:APT 110
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1564
Mailing Address - Country:US
Mailing Address - Phone:559-500-8201
Mailing Address - Fax:
Practice Address - Street 1:3555 W BULLARD AVE
Practice Address - Street 2:APT 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-1564
Practice Address - Country:US
Practice Address - Phone:559-500-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293397164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse