Basic Information
| Provider Information | |||||||||
| NPI: | 1548891880 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHALIN | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | LORRAINE | ||||||||
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| Credential: | NP-C, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 W PARK ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173374310 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1405 W PARK ST STE 301 | ||||||||
| Address2: | |||||||||
| City: | URBANA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618012367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173374310 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2020 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | F01200349 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.