Provider Demographics
NPI:1770943904
Name:WHALEN, SUZANNE M (APRN)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:WHALEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 STANLEY GAULT PKWY STE 129
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5176
Mailing Address - Country:US
Mailing Address - Phone:502-253-4900
Mailing Address - Fax:502-253-5751
Practice Address - Street 1:2400 EASTPOINT PKWY STE 550
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223
Practice Address - Country:US
Practice Address - Phone:502-253-6630
Practice Address - Fax:502-253-6639
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3010100363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100395460Medicaid
KY7100395460Medicaid