Healthcare Provider Details

I. General information

NPI: 1447763230
Provider Name (Legal Business Name): WHITNEY RENEE WHITE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 10/22/2022
Certification Date: 10/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9870 TELEGRAPH RD
TAYLOR MI
48180-3399
US

IV. Provider business mailing address

38699 NOTTINGHAM DR
ROMULUS MI
48174-6306
US

V. Phone/Fax

Practice location:
  • Phone: 313-291-6600
  • Fax:
Mailing address:
  • Phone: 734-363-7020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704272789
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: