Provider Demographics
NPI:1598029688
Name:WHALEN, ELAINE MARY (RN)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARY
Last Name:WHALEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 JOHN ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2017
Mailing Address - Country:US
Mailing Address - Phone:315-244-7741
Mailing Address - Fax:
Practice Address - Street 1:107 JOHN ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2017
Practice Address - Country:US
Practice Address - Phone:315-244-7741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY597044163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse