Provider Demographics
NPI:1053664870
Name:LAW, WHITNEY E (PA)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:E
Last Name:LAW
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4488
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:2300 PARK AVE.
Practice Address - Street 2:NEMOURS CHILDRENS CLINIC, ORANGE PARK
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-5573
Practice Address - Country:US
Practice Address - Phone:904-697-3694
Practice Address - Fax:904-697-3927
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2012-12-10
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106783363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant