Provider Demographics
NPI:1558639112
Name:WHALEY, AMANDA KRISTIN (NMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:KRISTIN
Last Name:WHALEY
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134 W CHEYENNE DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1708
Mailing Address - Country:US
Mailing Address - Phone:575-644-8239
Mailing Address - Fax:
Practice Address - Street 1:813 W ELLIOT RD
Practice Address - Street 2:SUITE 11
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-1886
Practice Address - Country:US
Practice Address - Phone:575-644-8239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-09
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11-1277175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath