Healthcare Provider Details

I. General information

NPI: 1043491095
Provider Name (Legal Business Name): CATHERINE A WHITE A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HIGHWAY 133
CARBONDALE CO
81623-1933
US

IV. Provider business mailing address

1340 HIGHWAY 133
CARBONDALE CO
81623-1933
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-3350
  • Fax: 970-963-2958
Mailing address:
  • Phone: 970-963-3350
  • Fax: 970-963-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number107523
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: