Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP07902 | LA |
NPI | 1003222027 |
---|---|
Provider Name | Christina White |
First Address | Jonesville, LA 71343-2432 |
Second Address | Jonesville, LA 71343-2432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2014 |
Last Update Date | 01/02/2016 |