Healthcare Provider Details

I. General information

NPI: 1912753377
Provider Name (Legal Business Name): BEVERLY WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2024
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 NORMAL BLVD
LINCOLN NE
68506-5551
US

IV. Provider business mailing address

151 N 8TH ST STE 350
LINCOLN NE
68508-1429
US

V. Phone/Fax

Practice location:
  • Phone: 402-488-2355
  • Fax:
Mailing address:
  • Phone: 402-770-4582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: