Provider Demographics
NPI:1508862434
Name:WHALEN, JOHANNA B (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:B
Last Name:WHALEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:865 LINCOLN RD
Mailing Address - Street 2:STE L10
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-355-9191
Mailing Address - Fax:563-355-3419
Practice Address - Street 1:1230 E RUSHOLME ST
Practice Address - Street 2:STE 301
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-2400
Practice Address - Country:US
Practice Address - Phone:563-322-9150
Practice Address - Fax:563-322-9148
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA21524207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4796890013OtherDMERC
029185OtherHEALTH ALLIANCE
19970OtherIOWA HEALTH SOLUTIONS
IA0161OtherJOHN DEERE HEALTH PLAN
40031OtherWELLMARK HEALTH PLAN
IA4009233Medicaid
IA0161OtherJOHN DEERE HEALTH PLAN
4796890013OtherDMERC