Provider Demographics
NPI:1730133877
Name:WHISENTON, NAOMI A (FNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:A
Last Name:WHISENTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14 OAKSHIRE CT
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3005
Mailing Address - Country:US
Mailing Address - Phone:314-348-6133
Mailing Address - Fax:636-447-6214
Practice Address - Street 1:161 WASHINGTON ST
Practice Address - Street 2:SUITE 1400 EIGHT TOWER BRIDGE
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-2083
Practice Address - Country:US
Practice Address - Phone:484-351-3218
Practice Address - Fax:484-351-3800
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MORN066870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423916303Medicaid