Provider Demographics
NPI:1194042861
Name:WHALEN, ELISE J (CRNP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:J
Last Name:WHALEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 OLD YORK RD
Mailing Address - Street 2:DIXON BLDG., SUITE 201
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-3720
Mailing Address - Country:US
Mailing Address - Phone:215-481-6839
Mailing Address - Fax:215-481-3515
Practice Address - Street 1:1200 OLD YORK RD
Practice Address - Street 2:DIXON BLDG., SUITE 201
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-3720
Practice Address - Country:US
Practice Address - Phone:215-481-6839
Practice Address - Fax:215-481-3515
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PASP004005C363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner