Healthcare Provider Details

I. General information

NPI: 1477801587
Provider Name (Legal Business Name): JOELLE CHRISTIANNE WHALEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 KEARNEY ST
FREMONT CA
94538-2299
US

IV. Provider business mailing address

1249 LAKESIDE DR APT 2047
SUNNYVALE CA
94085-1015
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22343
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: