Healthcare Provider Details

I. General information

NPI: 1174911846
Provider Name (Legal Business Name): PAULA M WHALEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 S SAGINAW RD SUITE E
GRAND BLANC MI
48439-8206
US

IV. Provider business mailing address

36123 SCHOOLCRAFT RD SUITE E
LIVONIA MI
48150-1216
US

V. Phone/Fax

Practice location:
  • Phone: 810-695-4000
  • Fax: 810-695-4055
Mailing address:
  • Phone: 734-793-6140
  • Fax: 734-402-0254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704231240
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704231240
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: