MEDICARE: MISS SHERREN M WHITE PA-C

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	363A00000X	Physician Assistant	5601004043	MI

General Provider Information

NPI Number	:	1710910641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SHERREN M WHITE PA-C

Provider Business Mailing Address
First Line	:	416 S CREYTS RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8290
Country	:	US
Telephone Number	:	517-886-0333
Fax Number	:	517-886-2072

Provider Business Practice Location Address
First Line	:	416 S CREYTS RD
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-8290
Country	:	US
Telephone Number	:	517-886-0333
Fax Number	:	517-886-2072

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	03/31/2008

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