Healthcare Provider Details

I. General information

NPI: 1396985073
Provider Name (Legal Business Name): WHITNEY SLEEP DIAGNOSTICS & CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 WASHINGTON AVE
DETROIT LAKES MN
56501-3012
US

IV. Provider business mailing address

119 GRAYSTONE PLZ SUITE 102
DETROIT LAKES MN
56501-3034
US

V. Phone/Fax

Practice location:
  • Phone: 218-844-6150
  • Fax: 763-201-5545
Mailing address:
  • Phone: 218-844-6150
  • Fax: 763-201-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number39456
License Number StateMN

VIII. Authorized Official

Name: DR. COURTNEY WADE WHITNEY
Title or Position: PHYSICIAN/PRESIDENT
Credential: D.O.
Phone: 218-844-6150