Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 27321 | NE |
N | 208000000X | Pediatrician | 4301063424 | MI |
N | 208000000X | Pediatrician | 7503 | SD |
NPI | 1053386672 |
---|---|
Provider Name | Lisa Ann White |
First Address | Sioux Falls, SD 57103-7693 |
Second Address | Omaha, NE 68114-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 02/04/2014 |