Provider Demographics
NPI:1972271278
Name:BEATON, WHITNEY (MSN, APNP, ACCNS-P)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:BEATON
Suffix:
Gender:F
Credentials:MSN, APNP, ACCNS-P
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:NIKOLE
Other - Last Name:BLAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:930 SKYLARK LN
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-2922
Mailing Address - Country:US
Mailing Address - Phone:620-290-2136
Mailing Address - Fax:
Practice Address - Street 1:1675 HIGHLAND AVE RM P7125
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0002
Practice Address - Country:US
Practice Address - Phone:620-290-2136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229951163W00000X
WI7614-33364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse