Healthcare Provider Details

I. General information

NPI: 1316542442
Provider Name (Legal Business Name): CHARLOTTE WHITE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 4TH AVE S
BIRMINGHAM AL
35233-1723
US

IV. Provider business mailing address

5900 SOUTHHALL RD
BIRMINGHAM AL
35213-1116
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9107
  • Fax:
Mailing address:
  • Phone: 601-917-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-174930
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-174930
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: