Healthcare Provider Details

I. General information

NPI: 1316954365
Provider Name (Legal Business Name): SANDRA LYNN WHISLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2724 VASSAR PL NE
ALBUQUERQUE NM
87107-1869
US

IV. Provider business mailing address

11216 DESERT CLASSIC LN NE
ALBUQUERQUE NM
87111-6599
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 505-440-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number92-157
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: