Healthcare Provider Details

I. General information

NPI: 1851828933
Provider Name (Legal Business Name): DEBRA E WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23790 S SHORE DR
EDWARDSBURG MI
49112-9563
US

IV. Provider business mailing address

23790 S SHORE DR
EDWARDSBURG MI
49112-9563
US

V. Phone/Fax

Practice location:
  • Phone: 260-710-6872
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28093191A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71007212A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: