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General NPI Number Information
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NPI Number | 1124784640
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Entity Type | Individual
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Provider Name | MARISA LAUREN WHITELAW CNM
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Gender | Female
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Dates
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Enumeration Date | 11/09/2021
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 315 SOUTH MANNING BLVD 3 MCAULEY
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City | ALBANY
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State | NY
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Zip | 12208-1707
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Country | US
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Telephone | 185-525-1381
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Fax | 518-525-1717
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Provider Business Mailing Address
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Address Line | PO BOX 14890
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City | ALBANY
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State | NY
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Zip | 12212-4890
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 948851
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 11015782
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 002319
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License Number State | NY
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