Provider Demographics
NPI:1437215688
Name:WHITNEY, JENNIFER A (RN, RCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:RN, RCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-6157
Mailing Address - Country:US
Mailing Address - Phone:920-860-6875
Mailing Address - Fax:
Practice Address - Street 1:1601 GEORGE ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-6157
Practice Address - Country:US
Practice Address - Phone:920-860-6875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR154040-4163W00000X
MNL050623-2164W00000X
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38352600Medicaid