Healthcare Provider Details

I. General information

NPI: 1326342007
Provider Name (Legal Business Name): NICHOLE RENEE WHITE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE WHITE RN, NP

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3536 W GLENDALE AVE
PHOENIX AZ
85051-8395
US

IV. Provider business mailing address

4390 MONTGOMERY RD
ELLICOTT CITY MD
21043-6068
US

V. Phone/Fax

Practice location:
  • Phone: 480-618-0177
  • Fax: 620-371-2243
Mailing address:
  • Phone: 410-203-1171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number255867
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR210152
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2264405
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2264405
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: