Provider Demographics
NPI:1063841773
Name:WHITING, ELYSE M (MSN, RN, CPN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ELYSE
Middle Name:M
Last Name:WHITING
Suffix:
Gender:F
Credentials:MSN, RN, CPN, FNP-C
Other - Prefix:
Other - First Name:ELYSE
Other - Middle Name:M
Other - Last Name:ANDREWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:409 S 2ND ST
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2645 N 3RD ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-2001
Practice Address - Country:US
Practice Address - Phone:717-782-4650
Practice Address - Fax:717-782-4665
Is Sole Proprietor?:No
Enumeration Date:2013-11-03
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP013422363LF0000X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102885587Medicaid
PA330306Medicare PIN