Healthcare Provider Details

I. General information

NPI: 1962096354
Provider Name (Legal Business Name): KAREN RENEE WHITE RN, NBC-HWC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E. INDIAN SCHOOL RD
PHOENIX AZ
85012
US

IV. Provider business mailing address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-277-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN085658
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: