Healthcare Provider Details

I. General information

NPI: 1205231081
Provider Name (Legal Business Name): MARY WHITTENHALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2014
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ONEIL BLVD
ATTLEBORO MA
02703-1854
US

IV. Provider business mailing address

20 ONEIL BLVD
ATTLEBORO MA
02703-1854
US

V. Phone/Fax

Practice location:
  • Phone: 508-699-6165
  • Fax: 508-342-1944
Mailing address:
  • Phone: 508-699-6165
  • Fax: 508-342-1944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN2264510
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN2264510
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN01320
License Number StateRI
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN01320
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: