Healthcare Provider Details

I. General information

NPI: 1891432084
Provider Name (Legal Business Name): WILLIAM JEFFERY WHIPPLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E MELROSE ST APT 3037
GILBERT AZ
85297-0094
US

IV. Provider business mailing address

1500 E MELROSE ST APT 3037
GILBERT AZ
85297-0094
US

V. Phone/Fax

Practice location:
  • Phone: 480-828-4238
  • Fax:
Mailing address:
  • Phone: 480-828-4238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number258980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: