Healthcare Provider Details

I. General information

NPI: 1508259938
Provider Name (Legal Business Name): TONYA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2643 GEORGIA DR
ARNOLD MO
63010-2919
US

IV. Provider business mailing address

2643 GEORGIA DR
ARNOLD MO
63010-2919
US

V. Phone/Fax

Practice location:
  • Phone: 636-375-0948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License Number352085
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: