Provider Demographics
NPI:1073927190
Name:MIKKELSEN, WHITNEY MICHELLE (BS)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:MICHELLE
Last Name:MIKKELSEN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORSO ASSISI
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6886
Mailing Address - Country:US
Mailing Address - Phone:307-389-9611
Mailing Address - Fax:
Practice Address - Street 1:2620 COMMERCIAL WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4671
Practice Address - Country:US
Practice Address - Phone:307-922-8543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator