Healthcare Provider Details

I. General information

NPI: 1700797032
Provider Name (Legal Business Name): NICOLE WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 N SCOTTSDALE RD STE 100
SCOTTSDALE AZ
85257-1370
US

IV. Provider business mailing address

2629 N SCOTTSDALE RD STE 100
SCOTTSDALE AZ
85257-1370
US

V. Phone/Fax

Practice location:
  • Phone: 248-722-6769
  • Fax:
Mailing address:
  • Phone: 248-722-6769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number297573
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number297573
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: