1841538543 NPI number — MS. GLYNELLE WHITE NURSE PRACTITIONER

Table of content: MS. GLYNELLE WHITE NURSE PRACTITIONER (NPI 1841538543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841538543 NPI number — MS. GLYNELLE WHITE NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHITE
Provider First Name:
GLYNELLE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
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:
1841538543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
362 N BEDFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRIDGEWATER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02333-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-350-2350
Provider Business Mailing Address Fax Number:
508-350-2318

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 COMPASS WAY
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
EAST BRIDGEWATER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02333-1465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-350-2222
Provider Business Practice Location Address Fax Number:
508-350-2316
Provider Enumeration Date:
01/30/2013

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: 363LP2300X , with the licence number:  198883 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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