Healthcare Provider Details

I. General information

NPI: 1902881196
Provider Name (Legal Business Name): DOROTHY JEAN WHITE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 I ST
LAPORTE IN
46350-5533
US

IV. Provider business mailing address

328 N MICHIGAN ST STE. 200
SOUTH BEND IN
46601-1244
US

V. Phone/Fax

Practice location:
  • Phone: 219-324-1700
  • Fax:
Mailing address:
  • Phone: 574-647-1845
  • Fax: 574-647-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000668A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: