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NPI Code Detail

MEDICARE: KIRSTIE RENEE WHITE

MEDICARE: KIRSTIE RENEE WHITE
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
1164W00000XLicensed Practical Nurse27067565AIN

General Provider Information

NPI Number : 1699408609
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTIE RENEE WHITE
Provider Business Mailing Address
First Line : 3640 N BRIARWOOD LN
Second Line :
City : MUNCIE
State : IN
Zip : 47304-6375
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3640 N BRIARWOOD LN
Second Line :
City : MUNCIE
State : IN
Zip : 47304-6375
Country : US
Telephone Number : 463-214-2523
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2022
Last Update Date : 07/07/2022

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Directions to “ KIRSTIE RENEE WHITE ” Practice Location

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