Individual
ELIZABETH WHITNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1600B CONGRESS ST, PORTLAND, ME 04102
(207) 774-5222
Mailing address
1600B CONGRESS ST, PORTLAND, ME 04102-2124
(207) 774-5222
(207) 761-4433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA897
ME
363A00000X
Physician Assistant
Primary
—
—
363AS0400X
Surgical Physician Assistant
PA-897
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
432093899
—
ME
Enumeration date
11/08/2006
Last updated
04/01/2019
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