Provider Demographics
NPI:1609205442
Name:WHALEY, MARLENE BLIZZARD (RN, MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:BLIZZARD
Last Name:WHALEY
Suffix:
Gender:F
Credentials:RN, MSN, FNP-C
Other - Prefix:MISS
Other - First Name:MARLENE
Other - Middle Name:MANUELA
Other - Last Name:BLIZZARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:NC
Mailing Address - Zip Code:28365-1701
Mailing Address - Country:US
Mailing Address - Phone:919-658-2505
Mailing Address - Fax:
Practice Address - Street 1:130 N CENTER ST
Practice Address - Street 2:
Practice Address - City:MOUNT OLIVE
Practice Address - State:NC
Practice Address - Zip Code:28365-1701
Practice Address - Country:US
Practice Address - Phone:919-658-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily