MEDICARE: MS. MICHELE MARIE WHAYLEN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10173	MN
2	363A00000X	Physician Assistant	079368	IA

General Provider Information

NPI Number	:	1689684292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELE MARIE WHAYLEN PA-C

Provider Business Mailing Address
First Line	:	200 HAWKINS DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52242-1009
Country	:	US
Telephone Number	:	319-356-2233
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 S CLINTON ST STE 168
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52240-4034
Country	:	US
Telephone Number	:	319-384-0520
Fax Number	:	319-467-8105

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	10/10/2024

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