Provider Demographics
NPI:1609025600
Name:WHITMER, MARY (FNP, BC-PCM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WHITMER
Suffix:
Gender:F
Credentials:FNP, BC-PCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2612
Mailing Address - Country:US
Mailing Address - Phone:602-239-6078
Mailing Address - Fax:602-239-5918
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:602-239-6078
Practice Address - Fax:602-239-5918
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN036796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZP22512Medicare UPIN
Z132279Medicare PIN
Z130368Medicare PIN