Provider Demographics
NPI:1336329473
Name:WHALON, WES (PHN)
Entity Type:Individual
Prefix:
First Name:WES
Middle Name:
Last Name:WHALON
Suffix:
Gender:M
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 NORTHGATE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3636
Mailing Address - Country:US
Mailing Address - Phone:415-473-6350
Mailing Address - Fax:415-473-6881
Practice Address - Street 1:899 NORTHGATE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3636
Practice Address - Country:US
Practice Address - Phone:415-473-6350
Practice Address - Fax:415-473-6881
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA431310163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management