Healthcare Provider Details

I. General information

NPI: 1780271247
Provider Name (Legal Business Name): ANNIE RUTH WHITE APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 MADISON ST
OAK PARK IL
60302-4111
US

IV. Provider business mailing address

345 MADISON ST
OAK PARK IL
60302-4111
US

V. Phone/Fax

Practice location:
  • Phone: 931-998-3097
  • Fax: 401-652-9787
Mailing address:
  • Phone: 931-998-3097
  • Fax: 401-652-9787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209022316
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209022316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: