1730133877 NPI number — NAOMI A WHISENTON FNP

Table of content: NAOMI A WHISENTON FNP (NPI 1730133877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730133877 NPI number — NAOMI A WHISENTON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHISENTON
Provider First Name:
NAOMI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730133877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 OAKSHIRE CT
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING
Provider Business Mailing Address City Name:
SAINT PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-348-6133
Provider Business Mailing Address Fax Number:
636-447-6214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
161 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 1400 EIGHT TOWER BRIDGE
Provider Business Practice Location Address City Name:
CONSHOHOCKEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19428-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-351-3218
Provider Business Practice Location Address Fax Number:
484-351-3800
Provider Enumeration Date:
05/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  RN066870 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 423916303 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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