Provider Demographics
NPI:1003307463
Name:WHITNEY, ALEXANDER (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 FEATHERSTONE RD STE C
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5904
Mailing Address - Country:US
Mailing Address - Phone:815-227-1055
Mailing Address - Fax:815-227-1006
Practice Address - Street 1:1055 FEATHERSTONE RD STE C
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5904
Practice Address - Country:US
Practice Address - Phone:815-227-1055
Practice Address - Fax:815-227-1006
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085006485363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical