Healthcare Provider Details

I. General information

NPI: 1114156833
Provider Name (Legal Business Name): JERRI ELISABETH WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10065 E HARVARD AVE
DENVER CO
80231-5968
US

IV. Provider business mailing address

5646 W 115TH PL
WESTMINSTER CO
80020-6845
US

V. Phone/Fax

Practice location:
  • Phone: 303-614-1536
  • Fax:
Mailing address:
  • Phone: 303-438-1754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number191229
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: