Healthcare Provider Details

I. General information

NPI: 1801846662
Provider Name (Legal Business Name): WHITNEY SLEEP ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 CAMPUS DR SUITE 100
PLYMOUTH MN
55441-2601
US

IV. Provider business mailing address

2700 CAMPUS DR SUITE 100
PLYMOUTH MN
55441-2601
US

V. Phone/Fax

Practice location:
  • Phone: 763-519-0634
  • Fax: 763-519-0636
Mailing address:
  • Phone: 763-519-0634
  • Fax: 763-519-0636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number39456
License Number StateMN

VIII. Authorized Official

Name: COURTNEY WADE WHITNEY
Title or Position: PRESIDENT
Credential: DO
Phone: 763-519-0634