Provider Demographics
NPI:1205667698
Name:WHITTREDGE, GEENA ELIZABETH (APRN)
Entity type:Individual
Prefix:
First Name:GEENA
Middle Name:ELIZABETH
Last Name:WHITTREDGE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:494 APPLETON ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-3211
Mailing Address - Country:US
Mailing Address - Phone:413-420-2303
Mailing Address - Fax:
Practice Address - Street 1:494 APPLETON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3211
Practice Address - Country:US
Practice Address - Phone:413-420-2303
Practice Address - Fax:413-534-2398
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-08
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN10012391163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse