Provider Demographics
NPI:1124112891
Name:WHITLOCK, JANELLE ANN (MS, RN, CNP)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:ANN
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:MS, RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 EVERMOOR PKWY
Mailing Address - Street 2:
Mailing Address - City:ROSEMOUNT
Mailing Address - State:MN
Mailing Address - Zip Code:55068-4466
Mailing Address - Country:US
Mailing Address - Phone:612-467-1442
Mailing Address - Fax:612-467-1332
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:VA MEDICAL CENTER CARDIOLOGY 111C
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-1442
Practice Address - Fax:612-467-1332
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR107381-6363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health