Provider Demographics
NPI:1447425293
Name:BANCROFT, WHITNEY MALYN (CNP)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:MALYN
Last Name:BANCROFT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MALYN
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:423 NO OREM BLVD
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057
Mailing Address - Country:US
Mailing Address - Phone:801-426-8141
Mailing Address - Fax:801-426-8142
Practice Address - Street 1:423 NO OREM BLVD
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057
Practice Address - Country:US
Practice Address - Phone:801-426-8141
Practice Address - Fax:801-426-8142
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1998324405363LF0000X
UT199832-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTQ00367Medicare UPIN