Provider Demographics
NPI:1881434595
Name:WHALEN, CHRISTA MARIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MARIE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4570 S DENISON AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9224
Mailing Address - Country:US
Mailing Address - Phone:724-991-1758
Mailing Address - Fax:
Practice Address - Street 1:2800 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-3038
Practice Address - Country:US
Practice Address - Phone:208-810-8615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID79487363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily