Healthcare Provider Details

I. General information

NPI: 1235625096
Provider Name (Legal Business Name): CARRIE MARIE WHITE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND RD N
PRINCE FREDERICK MD
20678-3917
US

IV. Provider business mailing address

PO BOX 1158
PRINCE FREDERICK MD
20678-1158
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-5400
  • Fax: 410-535-2220
Mailing address:
  • Phone: 410-535-5400
  • Fax: 410-535-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR193076
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: