Provider Demographics
NPI:1053620971
Name:WHITTINGTON-WASHINGTON, CAROL LISHA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LISHA
Last Name:WHITTINGTON-WASHINGTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6490 LANDOVER RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1443
Mailing Address - Country:US
Mailing Address - Phone:301-322-1696
Mailing Address - Fax:301-322-9122
Practice Address - Street 1:6490 LANDOVER RD
Practice Address - Street 2:SUITE H
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1443
Practice Address - Country:US
Practice Address - Phone:301-322-1696
Practice Address - Fax:301-322-9122
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR094051363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD146131100Medicaid