Healthcare Provider Details

I. General information

NPI: 1205370830
Provider Name (Legal Business Name): MICHELLE WHALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HAMPDEN AVE
ENGLEWOOD CO
80113-2702
US

IV. Provider business mailing address

501 E HAMPDEN AVE
ENGLEWOOD CO
80113-2702
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-6335
  • Fax:
Mailing address:
  • Phone: 303-788-6335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPN.0005560-CNS
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: