Provider Demographics
NPI:1629034848
Name:WHITMAN, SALLY J (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:J
Last Name:WHITMAN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:721 SHERIDAN AVE
Mailing Address - Street 2:STE 220
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3423
Mailing Address - Country:US
Mailing Address - Phone:307-587-1155
Mailing Address - Fax:307-587-1166
Practice Address - Street 1:721 SHERIDAN AVE
Practice Address - Street 2:STE 220
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3423
Practice Address - Country:US
Practice Address - Phone:307-587-1155
Practice Address - Fax:307-587-1166
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY316 TL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q67001Medicare UPIN