Provider Demographics
NPI:1487826764
Name:HOVENIC, WHITNEY WALDROUP (MD)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:WALDROUP
Last Name:HOVENIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:MICHEL
Other - Last Name:WALDROUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3950 GS RICHARDS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703
Mailing Address - Country:US
Mailing Address - Phone:775-882-8777
Mailing Address - Fax:775-888-8062
Practice Address - Street 1:640 W MOANA LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-4903
Practice Address - Country:US
Practice Address - Phone:775-324-0699
Practice Address - Fax:775-323-6814
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012017442207N00000X
CAA125661207NS0135X
NV15166207NS0135X
NV390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV107851OtherMEDICARE ID-TYPE UNSPECIFIED