Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 21162 | WI |
NPI | 1790700185 |
---|---|
Provider Name | John Whalen |
First Address | Bayside, WI 53217-1618 |
Second Address | Bayside, WI 53217-1618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 29/05/2014 |