Healthcare Provider Details

I. General information

NPI: 1487826764
Provider Name (Legal Business Name): WHITNEY WALDROUP HOVENIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY MICHEL WALDROUP M.D.

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W MOANA LN
RENO NV
89509-4903
US

IV. Provider business mailing address

3950 GS RICHARDS BLVD
CARSON CITY NV
89703
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-0699
  • Fax: 775-323-6814
Mailing address:
  • Phone: 775-882-8777
  • Fax: 775-888-8062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2012017442
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA125661
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number15166
License Number StateNV
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: