NPI 1346880341

Demetrius Whitehead, LPN

Practitioner Physical Disabilities Residential Treatment Facility Indianapolis, IN

Practice location

Address: 415 S Butler Ave, Indianapolis, IN 46219-7034
Phone: (317) 499-0437

Registered specialties (3)

Physical Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320700000X Licence 21015321 (IN)

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Licensed Practical Nurse

Nursing Service Providers Taxonomy 164W00000X Licence 27060564A (IN)

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Intellectual and/or Developmental Disabilities Residential Treatment Facility

Residential Treatment Facilities Taxonomy 320600000X Licence 21015321 (IN)

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Registry record

NPI: 1346880341
Entity type: Individual
Sex (as registered): Male
NPI issued: 8 Jan 2020
Record last updated: 28 Feb 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.