Provider Demographics
NPI:1982970588
Name:WHITENER, CONNIE R (BSN)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:R
Last Name:WHITENER
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:R
Other - Last Name:PLUMB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12033 AGENCY ROAD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:AZ
Mailing Address - Zip Code:85344
Mailing Address - Country:US
Mailing Address - Phone:928-669-2137
Mailing Address - Fax:928-663-3131
Practice Address - Street 1:12033 AGENCY RD
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:AZ
Practice Address - Zip Code:85344-7718
Practice Address - Country:US
Practice Address - Phone:928-669-2137
Practice Address - Fax:928-669-3131
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60098710163W00000X
AZRN156695163WC0400X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care