Healthcare Provider Details

I. General information

NPI: 1679794655
Provider Name (Legal Business Name): NICHOLAS WHITE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 09/28/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER UNIT 33100
APO AE
09180-3100
US

IV. Provider business mailing address

CMR 467 BOX 4416
APO AE
09096-0045
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-1368
  • Fax:
Mailing address:
  • Phone: 314-590-1368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26596
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number956
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: