Healthcare Provider Details

I. General information

NPI: 1104300979
Provider Name (Legal Business Name): MICHELLE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MILLBURY ST
WORCESTER MA
01610-2177
US

IV. Provider business mailing address

237 MILLBURY ST
WORCESTER MA
01610-2177
US

V. Phone/Fax

Practice location:
  • Phone: 508-755-1228
  • Fax: 508-754-0668
Mailing address:
  • Phone: 508-755-1228
  • Fax: 508-754-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: