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NPI Code Detail

MEDICARE: DR. WHITNEY WALDROUP HOVENIC M.D.

MEDICARE: DR. WHITNEY WALDROUP HOVENIC M.D.
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
1207N00000XDermatology Physician2012017442MO
2207NS0135XProcedural Dermatology PhysicianA125661CA
3207NS0135XProcedural Dermatology Physician15166NV
4390200000XStudent in an Organized Health Care Education/Training ProgramNV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1V107851OTHERNVMEDICARE ID-TYPE UNSPECIFIED

General Provider Information

NPI Number : 1487826764
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WHITNEY WALDROUP HOVENIC M.D.
Provider Business Mailing Address
First Line : 3950 GS RICHARDS BLVD
Second Line :
City : CARSON CITY
State : NV
Zip : 89703
Country : US
Telephone Number : 775-882-8777
Fax Number : 775-888-8062
Provider Business Practice Location Address
First Line : 640 W MOANA LN
Second Line :
City : RENO
State : NV
Zip : 89509-4903
Country : US
Telephone Number : 775-324-0699
Fax Number : 775-323-6814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2008
Last Update Date : 12/12/2014

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