Provider Demographics
NPI:1194002832
Name:THOMAS-WHITMAN, TERESA L (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:THOMAS-WHITMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:L
Other - Last Name:THOMAS-WHITMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:351 HOSPITAL RD
Mailing Address - Street 2:SUITE 611
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3509
Mailing Address - Country:US
Mailing Address - Phone:949-642-1363
Mailing Address - Fax:
Practice Address - Street 1:351 HOSPITAL RD
Practice Address - Street 2:SUITE 611
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3509
Practice Address - Country:US
Practice Address - Phone:949-642-1363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF917363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health