Healthcare Provider Details

I. General information

NPI: 1902139090
Provider Name (Legal Business Name): PATI MICHELE WHELAN-GONZALES RN,MS,WHCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W UNIVERSITY DR
MESA AZ
85201-5627
US

IV. Provider business mailing address

504 W UNIVERSITY DR
MESA AZ
85201-5627
US

V. Phone/Fax

Practice location:
  • Phone: 480-238-6109
  • Fax: 480-491-4846
Mailing address:
  • Phone: 480-238-6109
  • Fax: 480-491-4846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN038811
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number123
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: