Provider Demographics
NPI:1134253586
Name:WHALEN, DEIDRA L (OPA-C)
Entity type:Individual
Prefix:MRS
First Name:DEIDRA
Middle Name:L
Last Name:WHALEN
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Gender:F
Credentials:OPA-C
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Mailing Address - Street 1:1918 RANDOLPH RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1100
Mailing Address - Country:US
Mailing Address - Phone:704-348-3544
Mailing Address - Fax:704-370-6652
Practice Address - Street 1:1918 RANDOLPH RD
Practice Address - Street 2:SUITE 700
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1100
Practice Address - Country:US
Practice Address - Phone:704-342-3544
Practice Address - Fax:704-370-6652
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2013-07-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist