MEDICARE: SARAH JO WHITE FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN129750	AZ

General Provider Information

NPI Number	:	1154312957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JO WHITE FNP

Provider Business Mailing Address
First Line	:	610 W GLENN DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-8700
Country	:	US
Telephone Number	:	602-466-2389
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 N 3RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-1471
Country	:	US
Telephone Number	:	602-462-1132
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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