Healthcare Provider Details

I. General information

NPI: 1194059170
Provider Name (Legal Business Name): JODI RUTH WHITE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JODI RUTH WHITE-JOHNSON CRNA

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 04/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

468 CADIEUX RD
GROSSE POINTE MI
48230-1507
US

IV. Provider business mailing address

750 STEPHENSON HWY PAYOR CONTRACT SERVICES
TROY MI
48083-1103
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-1684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704248249
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: