Healthcare Provider Details

I. General information

NPI: 1811598782
Provider Name (Legal Business Name): AMY L WHALEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 ENTERPRISE RD
RENO NV
89512-1666
US

IV. Provider business mailing address

2655 ENTERPRISE RD
RENO NV
89512-1666
US

V. Phone/Fax

Practice location:
  • Phone: 775-688-2416
  • Fax:
Mailing address:
  • Phone: 775-688-2416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN83660
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: