Healthcare Provider Details

I. General information

NPI: 1770400251
Provider Name (Legal Business Name): DONNIESE ANDREA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 FREEPORT BLVD # 8
SACRAMENTO CA
95818-4379
US

IV. Provider business mailing address

PO BOX 2055
ELK GROVE CA
95759-2055
US

V. Phone/Fax

Practice location:
  • Phone: 916-891-7114
  • Fax:
Mailing address:
  • Phone: 916-891-7114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number23531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: