Provider Demographics
NPI:1497933329
Name:WHELAN, COLETTE (FNP)
Entity Type:Individual
Prefix:
First Name:COLETTE
Middle Name:
Last Name:WHELAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S FIR ST
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-1218
Mailing Address - Country:US
Mailing Address - Phone:541-280-1153
Mailing Address - Fax:
Practice Address - Street 1:880 E END RD
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7201
Practice Address - Country:US
Practice Address - Phone:907-226-2228
Practice Address - Fax:907-226-2230
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147545163W00000X
OR092006227RN163W00000X
AK149102363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse