Healthcare Provider Details

I. General information

NPI: 1477824720
Provider Name (Legal Business Name): COURTNEY LEIGH WHITE MSN, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY LEIGH SANDIFER RN

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE MAIN BUILDING ROOM 3C38
SAN FRANCISCO CA
94110-3518
US

IV. Provider business mailing address

1786 43RD AVE
SAN FRANCISCO CA
94122-4010
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-8145
  • Fax: 415-206-6014
Mailing address:
  • Phone: 251-391-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA: 4156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: