Provider Demographics
NPI:1053961268
Name:WHALEN, EILEEN (NP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:WHALEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6431 FANNIN ST
Mailing Address - Street 2:MSB 7.044
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77939-6308
Mailing Address - Country:US
Mailing Address - Phone:713-500-8935
Mailing Address - Fax:
Practice Address - Street 1:1941 EAST RD # 4358
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-6010
Practice Address - Country:US
Practice Address - Phone:713-486-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9623363L00000X
CANP95016188363L00000X
TX1161651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner