MEDICARE: DR. DEBRA M WHIPPLE FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	53869	ID
2	363L00000X	Nurse Practitioner	217729-4405	UT

General Provider Information

NPI Number	:	1235128877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA M WHIPPLE FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 990
Second Line	:
City	:	DRIGGS
State	:	ID
Zip	:	83422-0990
Country	:	US
Telephone Number	:	801-814-7567
Fax Number	:

Provider Business Practice Location Address
First Line	:	3246 N 1500 E
Second Line	:
City	:	DRIGGS
State	:	ID
Zip	:	83422
Country	:	US
Telephone Number	:	801-814-7567
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2005
Last Update Date	:	01/04/2017

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