Provider Demographics
NPI:1932717410
Name:WHALEN, PAULETTE JO (NP)
Entity Type:Individual
Prefix:
First Name:PAULETTE
Middle Name:JO
Last Name:WHALEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W267S7535 OLYMPIA CT N
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-9637
Mailing Address - Country:US
Mailing Address - Phone:414-315-6607
Mailing Address - Fax:
Practice Address - Street 1:W267S7535 OLYMPIA CT N
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-9637
Practice Address - Country:US
Practice Address - Phone:414-315-6607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15701730163WH0200X
WI10225-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI157017-30OtherRN