Healthcare Provider Details

I. General information

NPI: 1982970588
Provider Name (Legal Business Name): CONNIE R WHITENER BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. CONNIE R PLUMB

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY RD
PARKER AZ
85344-7718
US

IV. Provider business mailing address

12033 AGENCY ROAD
PARKER AZ
85344
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-2137
  • Fax: 928-669-3131
Mailing address:
  • Phone: 928-669-2137
  • Fax: 928-663-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60098710
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN156695
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN156695
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: