Healthcare Provider Details

I. General information

NPI: 1336824986
Provider Name (Legal Business Name): AMY MARIE WHITE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2645 E SOUTHERN AVE
TEMPE AZ
85282-7649
US

IV. Provider business mailing address

PO BOX 511250
LOS ANGELES CA
90051-7805
US

V. Phone/Fax

Practice location:
  • Phone: 623-624-8280
  • Fax: 602-835-0192
Mailing address:
  • Phone: 510-929-1400
  • Fax: 510-929-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number292953
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: