Healthcare Provider Details

I. General information

NPI: 1891853321
Provider Name (Legal Business Name): PATRICIA A WHITE N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6153 W OLIVE AVE
GLENDALE AZ
85302-4564
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 200
PHOENIX AZ
85012-2914
US

V. Phone/Fax

Practice location:
  • Phone: 602-685-6000
  • Fax: 623-937-2589
Mailing address:
  • Phone: 602-685-6000
  • Fax: 602-685-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP1776
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberAP1776
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: