Healthcare Provider Details

I. General information

NPI: 1609267178
Provider Name (Legal Business Name): JENNIFER M. WHITE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2015
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7801 YORK RD SUITE #102
TOWSON MD
21204-7446
US

IV. Provider business mailing address

7801 YORK RD SUITE #102
TOWSON MD
21204-7446
US

V. Phone/Fax

Practice location:
  • Phone: 410-769-4920
  • Fax:
Mailing address:
  • Phone: 410-769-4920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR161696
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: