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General NPI Number Information
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NPI Number | 1508862434
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Entity Type | Individual
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Provider Name | JOHANNA B WHALEN MD
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Gender | Female
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Dates
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Enumeration Date | 06/24/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1230 E RUSHOLME ST STE 301
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City | DAVENPORT
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State | IA
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Zip | 52803-2400
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Country | US
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Telephone | 563-322-9150
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Fax | 563-322-9148
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Provider Business Mailing Address
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Address Line | 865 LINCOLN RD STE L10
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City | BETTENDORF
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State | IA
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Zip | 52722-4159
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Country | US
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Telephone | 563-355-9191
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Fax | 563-355-3419
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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 | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 21524
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License Number State | IA
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