Healthcare Provider Details

I. General information

NPI: 1912937004
Provider Name (Legal Business Name): EVANGELINE A WHITE RNFA, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 N HIGLEY RD STE 308
GILBERT AZ
85234-1625
US

IV. Provider business mailing address

1920 N HIGLEY RD STE 308
GILBERT AZ
85234-1625
US

V. Phone/Fax

Practice location:
  • Phone: 480-543-6600
  • Fax: 480-543-6733
Mailing address:
  • Phone: 480-543-6600
  • Fax: 480-543-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2831
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN040399
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: