Provider Demographics
NPI:1811088776
Name:WHYE, MONIQUE VAN AKEN (FNP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:VAN AKEN
Last Name:WHYE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4646 BROCKTON AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-0104
Mailing Address - Country:US
Mailing Address - Phone:951-231-1325
Mailing Address - Fax:951-231-1372
Practice Address - Street 1:4646 BROCKTON AVE STE 203
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-0104
Practice Address - Country:US
Practice Address - Phone:951-774-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 7284363LF0000X
CA16927363LF0000X
TNAPN0000011687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1871689315OtherNPI- CHAP
CAFHC70768FMedicaid
CAHAP70768FMedicaid
CAEAP70768FMedicaid
CAEAP70768FMedicaid