Provider Demographics
NPI:1144323155
Name:WHITNEY, MICHELLE L (ARNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34960
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1960
Mailing Address - Country:US
Mailing Address - Phone:425-688-5759
Mailing Address - Fax:425-688-5101
Practice Address - Street 1:1035 116TH AVENUE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-688-5759
Practice Address - Fax:425-688-5101
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA30003945363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9619461Medicaid
WA9619461Medicaid
AB23376Medicare ID - Type Unspecified