Healthcare Provider Details

I. General information

NPI: 1700979176
Provider Name (Legal Business Name): PHILIP FRANCIS WHALEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GODWIN BLVD
SUFFOLK VA
23434
US

IV. Provider business mailing address

3304 MORNINGSIDE DR
CHESAPEAKE VA
23321-4614
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4000
  • Fax:
Mailing address:
  • Phone: 757-483-8951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024110281
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: