Provider Demographics
NPI:1174647390
Name:WHITING, ANN MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:WHITING
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15848 SPRINGBROOK CT
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-3616
Mailing Address - Country:US
Mailing Address - Phone:503-636-0943
Mailing Address - Fax:
Practice Address - Street 1:0615 SW PALATINE HILL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-7879
Practice Address - Country:US
Practice Address - Phone:503-768-7165
Practice Address - Fax:503-768-7167
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000036298N2363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics