Healthcare Provider Details

I. General information

NPI: 1699073445
Provider Name (Legal Business Name): LAUREN PEELER WHITE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 S 84TH ST
LA VISTA NE
68128-2127
US

IV. Provider business mailing address

4854 B ST
OMAHA NE
68106-4551
US

V. Phone/Fax

Practice location:
  • Phone: 402-339-1090
  • Fax:
Mailing address:
  • Phone: 402-216-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1579
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1579
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: