Healthcare Provider Details

I. General information

NPI: 1861886897
Provider Name (Legal Business Name): WHITNEY WELLENSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2015
Last Update Date: 12/11/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S HEALTH CARE 2525 CHICAGO AVE S
MINNEAPOLIS MN
55404-4518
US

IV. Provider business mailing address

CHILDREN'S HEALTH CARE 2525 CHICAGO AVENUE SOUTH
MINNEAPOLIS MN
55404-4518
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-5999
  • Fax:
Mailing address:
  • Phone: 651-220-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101272475
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number76981
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: