Basic Information
| Provider Information | |||||||||
| NPI: | 1497024343 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITING | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | APN-ANESTHESIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT HOLLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080602038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092611660 | ||||||||
| FaxNumber: | 6092614454 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | MOUNT HOLLY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080602038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6092611660 | ||||||||
| FaxNumber: | 6092614454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2011 | ||||||||
| LastUpdateDate: | 12/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 26NJ00359100 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.