Healthcare Provider Details

I. General information

NPI: 1972271278
Provider Name (Legal Business Name): WHITNEY BEATON MSN, APNP, ACCNS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WHITNEY NIKOLE BLAU

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 HIGHLAND AVE RM P7125
MADISON WI
53792-0002
US

IV. Provider business mailing address

930 SKYLARK LN
DEFOREST WI
53532-2922
US

V. Phone/Fax

Practice location:
  • Phone: 620-290-2136
  • Fax:
Mailing address:
  • Phone: 620-290-2136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number229951
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number7614-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: