Healthcare Provider Details

I. General information

NPI: 1982153565
Provider Name (Legal Business Name): JARVARA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17410 MACK AVE # 1045
GROSSE POINTE MI
48230-6228
US

IV. Provider business mailing address

15564 LINCOLN AVE
EASTPOINTE MI
48021-2918
US

V. Phone/Fax

Practice location:
  • Phone: 313-443-5919
  • Fax:
Mailing address:
  • Phone: 313-443-5919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAS820380700
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code246QL0900X
TaxonomyLaboratory Management Specialist/Technologist
License Number
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateMI
# 5
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMI
# 7
Primary TaxonomyN
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: