Provider Demographics
NPI:1952771370
Name:BROCK, WHITNEY WARDLAW (DNP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:WARDLAW
Last Name:BROCK
Suffix:
Gender:F
Credentials:DNP
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Mailing Address - Street 1:3020 CHILDRENS WAY
Mailing Address - Street 2:MC 5008
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-966-5818
Mailing Address - Fax:858-966-7483
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:MC 5008
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-5818
Practice Address - Fax:858-966-7483
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2021-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA95071812163WN0002X
CA4371364SN0000X
CA95003123363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No364SN0000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistNeonatal