Basic Information
| Provider Information | |||||||||
| NPI: | 1841566023 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITMORE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LINDSAY | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 LAS VEGAS BLVD N | ||||||||
| Address2: | |||||||||
| City: | NELLIS AFB | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891916600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026533800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3100 N TENAYA WAY | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891280436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029625000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2012 | ||||||||
| LastUpdateDate: | 10/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DO2579 | NV | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0102203793 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0102203793 | 01 | VA | VIRGINIA MEDICAL LICENSE | OTHER |