MEDICARE: THOMAS R WHITE CRNP

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	VP005750B	PA

General Provider Information

NPI Number	:	1518928340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS R WHITE CRNP

Provider Business Mailing Address
First Line	:	153 E 13TH ST STE 1300
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16503-1035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 N MAIN ST
Second Line	:
City	:	UNION CITY
State	:	PA
Zip	:	16438-1068
Country	:	US
Telephone Number	:	814-438-7208
Fax Number	:	814-438-8062

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	11/10/2020

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Directions to “ THOMAS R WHITE CRNP” Practice Location

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