Healthcare Provider Details

I. General information

NPI: 1508102674
Provider Name (Legal Business Name): JOAN MARIE HULDAH WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 E THOMAS RD
PHOENIX AZ
85016-7711
US

IV. Provider business mailing address

4422 W VILLA THERESA DR
GLENDALE AZ
85308-1630
US

V. Phone/Fax

Practice location:
  • Phone: 602-532-2160
  • Fax: 602-532-2008
Mailing address:
  • Phone: 602-487-6862
  • Fax: 602-532-2008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: