MEDICARE: LINDA LOUISE WHITE NP

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	363L00000X	Nurse Practitioner	4704137552	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184666380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA LOUISE WHITE NP

Provider Business Mailing Address
First Line	:	1061 S BEACON BLVD STE 200
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2588
Country	:	US
Telephone Number	:	616-846-2015
Fax Number	:	616-846-7227

Provider Business Practice Location Address
First Line	:	1061 S BEACON BLVD STE 200
Second Line	:
City	:	GRAND HAVEN
State	:	MI
Zip	:	49417-2588
Country	:	US
Telephone Number	:	616-846-2015
Fax Number	:	616-846-7227

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	02/03/2020

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