Healthcare Provider Details

I. General information

NPI: 1598567661
Provider Name (Legal Business Name): MARY L WHITE RNC-NIC, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 PINE GLEN DR
ALBANY GA
31705-5349
US

IV. Provider business mailing address

406 PINE GLEN DR
ALBANY GA
31705-5349
US

V. Phone/Fax

Practice location:
  • Phone: 229-376-6911
  • Fax:
Mailing address:
  • Phone: 229-376-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN169539
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: