1194081885 NPI number — DIANE MARIE WHITE RN NP-C

Table of content: DIANE MARIE WHITE RN NP-C (NPI 1194081885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194081885 NPI number — DIANE MARIE WHITE RN NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
DIANE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194081885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2807 N GLEBE RD
Provider Second Line Business Mailing Address:
MARYMOUNT UNIVERSITY STUDENT HEALTH CENTER
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22207-4224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-284-1610
Provider Business Mailing Address Fax Number:
703-284-3816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2807 N GLEBE RD
Provider Second Line Business Practice Location Address:
MARYMOUNT UNIVERSITY STUDENT HEALTH CENTER
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22207-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-284-1610
Provider Business Practice Location Address Fax Number:
703-284-3816
Provider Enumeration Date:
04/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024114870 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0024114870 . This is a "COMMONWEALTH OF VIRGINIA LISCENSE TO PRACTICE AS NP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0017001008 . This is a "COMMONWEALTH OF VIRGINIA AUTHORIZATION TO PRESCRIBE LIC NP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001114870 . This is a "COMMONWEALTH OF VIRGINIA LISCENSE TO PRACTICE AS RN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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