Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 71006501A | IN |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2019035100 | IN |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71006501A | IN |
NPI | 1003369091 |
---|---|
Provider Name | Shanna Lynn White |
First Address | Shelburn, IN 47879-1202 |
Second Address | Shelburn, IN 47879-1202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2016 |
Last Update Date | 23/03/2021 |