Provider Demographics
NPI:1932667490
Name:WHALEN, CAROLINE STONE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:STONE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SCHOOL RD
Mailing Address - Street 2:STE 125
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-4790
Mailing Address - Country:US
Mailing Address - Phone:970-668-2510
Mailing Address - Fax:
Practice Address - Street 1:18 SCHOOL RD
Practice Address - Street 2:STE 125
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-4790
Practice Address - Country:US
Practice Address - Phone:970-668-2510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant