Healthcare Provider Details

I. General information

NPI: 1164666400
Provider Name (Legal Business Name): CONSTANCE JILL WHITROCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 04/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SUNSET DR # 3
SITKA AK
99835-9515
US

IV. Provider business mailing address

222 TONGASS DR
SITKA AK
99835-9416
US

V. Phone/Fax

Practice location:
  • Phone: 970-623-9982
  • Fax:
Mailing address:
  • Phone: 970-966-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number29152
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: