Provider Demographics
NPI:1558786947
Name:WHITNEY, TERI
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 VAN NESS AVE
Mailing Address - Street 2:STE 2300
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6020
Mailing Address - Country:US
Mailing Address - Phone:415-581-2423
Mailing Address - Fax:
Practice Address - Street 1:30 VAN NESS AVE
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6020
Practice Address - Country:US
Practice Address - Phone:415-581-3423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker