Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | M2498 | TX |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | M2498 | TX |
NPI | 1164642237 |
---|---|
Provider Name | Amanda Bone White |
First Address | Austin, TX 78701-1137 |
Second Address | Austin, TX 78705-1188 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2007 |
Last Update Date | 10/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
191148905 | (05) | TX |
191148906 | (05) | TX |