Basic Information
| Provider Information | |||||||||
| NPI: | 1750944492 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITELEY | ||||||||
| FirstName: | GEORGIANNA | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 CARING WAY | ||||||||
| Address2: | |||||||||
| City: | REDWOOD FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562832624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076372985 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 101 CARING WAY | ||||||||
| Address2: | |||||||||
| City: | REDWOOD FALLS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 562832624 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5076372985 | ||||||||
| FaxNumber: | 5076976679 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2019 | ||||||||
| LastUpdateDate: | 07/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | DR.0064926 | CO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 71022 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.