Healthcare Provider Details

I. General information

NPI: 1073833273
Provider Name (Legal Business Name): JANICE MARY WHITING NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1304 CHINOOK LN
PUEBLO CO
81001-1851
US

IV. Provider business mailing address

1304 CHINOOK LN
PUEBLO CO
81001-1851
US

V. Phone/Fax

Practice location:
  • Phone: 719-545-2746
  • Fax:
Mailing address:
  • Phone: 719-545-2746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0992059-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN14074
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: