1114277944 NPI number — MRS. ANGELA J WHITE FNP

Table of content: MRS. ANGELA J WHITE FNP (NPI 1114277944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114277944 NPI number — MRS. ANGELA J WHITE FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
ANGELA
Provider Middle Name:
J
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1114277944
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5009 RIVERCHASE DR
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
PHENIX CITY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36867-7490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-448-9505
Provider Business Mailing Address Fax Number:
334-448-9575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5009 RIVERCHASE DR
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
PHENIX CITY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36867-7490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-448-9505
Provider Business Practice Location Address Fax Number:
334-448-9575
Provider Enumeration Date:
09/19/2012

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:  1-074021 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1-074021 . This is a "STATE OF ALABAMA NURSE PRACTITIONER LICENSE" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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