Provider Demographics
NPI:1164441226
Name:WHITNEY, WENDY (FNP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 E 3135 S
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84109-2116
Mailing Address - Country:US
Mailing Address - Phone:801-486-0883
Mailing Address - Fax:
Practice Address - Street 1:855 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84104-1632
Practice Address - Country:US
Practice Address - Phone:801-977-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT211711-4405363LF0000X, 363LA2100X
AK828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT211711-4405OtherSTATE LICENSE
AK828OtherSTATE LICENSE