1740586809 NPI number — MRS. AMANDA MICHELLE WHITE

Table of content: DR. HARVEY S. MISHNER M.D. (NPI 1790777159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740586809 NPI number — MRS. AMANDA MICHELLE WHITE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
AMANDA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHRISTEN
Provider Other First Name:
AMANDA
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740586809
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5647 WITTMER MEADOWS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45150-8802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-254-5175
Provider Business Mailing Address Fax Number:
513-672-0580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5647 WITTMER MEADOWS DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILFORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45150-8802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-254-5175
Provider Business Practice Location Address Fax Number:
513-672-0580
Provider Enumeration Date:
02/07/2011

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: 222Q00000X , with the licence number:  74580 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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