1194190058 NPI number — MRS. HANNAH NICHOLS WHITE R.D.

Table of content: MRS. HANNAH NICHOLS WHITE R.D. (NPI 1194190058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194190058 NPI number — MRS. HANNAH NICHOLS WHITE R.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
HANNAH
Provider Middle Name:
NICHOLS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICHOLS
Provider Other First Name:
HANNAH
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194190058
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 VILLA RD
Provider Second Line Business Mailing Address:
SUITE 420
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29615-3037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-522-3128
Provider Business Mailing Address Fax Number:
864-522-3149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 VILLA RD
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29615-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-522-3128
Provider Business Practice Location Address Fax Number:
864-522-3149
Provider Enumeration Date:
12/03/2015

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: 133V00000X , with the licence number:  1290 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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