Provider Demographics
NPI:1427667005
Name:WHALEN, JUANITA KU'UIPO (MA 60802740)
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:KU'UIPO
Last Name:WHALEN
Suffix:
Gender:F
Credentials:MA 60802740
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 MIA ST NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-1401
Mailing Address - Country:US
Mailing Address - Phone:808-227-1969
Mailing Address - Fax:
Practice Address - Street 1:3912 MARTIN WAY E
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5220
Practice Address - Country:US
Practice Address - Phone:360-459-9780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist