Healthcare Provider Details

I. General information

NPI: 1780407601
Provider Name (Legal Business Name): PHYLLIS L WHALEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 MAPLECREST RD
BETTENDORF IA
52722-7709
US

IV. Provider business mailing address

1351 W CENTRAL PARK AVE STE 4100
DAVENPORT IA
52804-1847
US

V. Phone/Fax

Practice location:
  • Phone: 563-421-4620
  • Fax:
Mailing address:
  • Phone: 563-355-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA181009
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: