Provider Demographics
NPI:1932479664
Name:WHITELOW, MICHELLE L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:WHITELOW
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2214 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3221
Mailing Address - Country:US
Mailing Address - Phone:309-680-7660
Mailing Address - Fax:309-681-8443
Practice Address - Street 1:711 W JOHN GWYNN JR. AVENUE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605
Practice Address - Country:US
Practice Address - Phone:309-680-7600
Practice Address - Fax:309-671-2188
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-009324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily