Provider Demographics
NPI:1811034465
Name:WHITTLESEY, DORIS (PA-C)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:
Last Name:WHITTLESEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 SIERRA COLLEGE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-5763
Mailing Address - Country:US
Mailing Address - Phone:530-273-8452
Mailing Address - Fax:530-477-5182
Practice Address - Street 1:280 SIERRA COLLEGE DR STE 205
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5763
Practice Address - Country:US
Practice Address - Phone:530-273-8452
Practice Address - Fax:530-477-5182
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14565363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPA145650Medicare ID - Type Unspecified