MEDICARE: WHITNEY ANNE WHITTLE

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	163W00000X	Registered Nurse	79213	ID

General Provider Information

NPI Number	:	1316878945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY ANNE WHITTLE

Provider Business Mailing Address
First Line	:	2958 ESCALANTE AVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7266
Country	:	US
Telephone Number	:	208-360-5440
Fax Number	:

Provider Business Practice Location Address
First Line	:	2958 ESCALANTE AVE
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7266
Country	:	US
Telephone Number	:	208-360-5440
Fax Number	:

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

Provider Enumeration Date	:	05/25/2026
Last Update Date	:	05/25/2026

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Directions to “ WHITNEY ANNE WHITTLE ” Practice Location

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