Healthcare Provider Details

I. General information

NPI: 1831411834
Provider Name (Legal Business Name): NICOLE WHITE LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE WHITE LVN

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 02/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7155 MISSION GORGE RD
SAN DIEGO CA
92120-1130
US

IV. Provider business mailing address

7155 MISSION GORGE RD
SAN DIEGO CA
92120-1130
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-0460
  • Fax: 858-300-0461
Mailing address:
  • Phone: 858-300-0460
  • Fax: 858-300-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number226843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: