Provider Demographics
NPI:1285615658
Name:WHALEN, JEANNE L (RN)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:L
Last Name:WHALEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:STE 368A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-872-7958
Mailing Address - Fax:314-872-7938
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:STE 368A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-872-7958
Practice Address - Fax:314-872-7938
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112305163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO112305OtherMO STATE BOARD OF NURSING