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General NPI Number Information
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NPI Number | 1861461329
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Entity Type | Individual
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Provider Name | COURTNEY WADE WHITNEY D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2006
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Last Update Date | 01/20/2012
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Provider Practice Location Address
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Address Line | 2700 CAMPUS DRIVE SUITE 100
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 763-519-0634
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Fax | 763-519-0636
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Provider Business Mailing Address
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Address Line | 2700 CAMPUS DRIVE SUITE 100
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City | PLYMOUTH
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State | MN
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Zip | 55441
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Country | US
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Telephone | 763-319-0634
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Fax | 763-519-0636
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39456
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 39456
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License Number State | MN
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