Healthcare Provider Details

I. General information

NPI: 1669036034
Provider Name (Legal Business Name): DEBORAH LYNN WHITE DNP, MHA, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH LYNN GARDNER DNP, MHA, APRN, FNPC

II. Dates (important events)

Enumeration Date: 04/30/2019
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 E BROWN RD STE 100
MESA AZ
85205-8007
US

IV. Provider business mailing address

4855 E BROWN RD STE 100
MESA AZ
85205-8007
US

V. Phone/Fax

Practice location:
  • Phone: 480-219-6466
  • Fax: 480-219-6647
Mailing address:
  • Phone: 480-219-6466
  • Fax: 480-219-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN189186
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP228212
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: