Provider Demographics
NPI:1467072033
Name:WHALEN, SARAH MICHELLE (APRN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MICHELLE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 JEFFERSON SQ
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1109
Mailing Address - Country:US
Mailing Address - Phone:860-793-3548
Mailing Address - Fax:
Practice Address - Street 1:100 JEFFERSON SQ
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1109
Practice Address - Country:US
Practice Address - Phone:860-793-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8832363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health