Provider Demographics
NPI:1548502446
Name:SHOFNER MICHALSKY, WHITNEY LEIGH (MD)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEIGH
Last Name:SHOFNER MICHALSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 E BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6241
Mailing Address - Country:US
Mailing Address - Phone:206-386-2123
Mailing Address - Fax:206-386-6293
Practice Address - Street 1:190 E BANNOCK ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83712-6241
Practice Address - Country:US
Practice Address - Phone:206-386-2123
Practice Address - Fax:206-386-6293
Is Sole Proprietor?:No
Enumeration Date:2013-03-19
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-146732085R0202X
WA605855042085R0202X
WAMDRE.ML.60375715208600000X
IDM146732085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery