Healthcare Provider Details

I. General information

NPI: 1841602232
Provider Name (Legal Business Name): TARIKA W. WHITE CNM.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE BLDG 200 SUITE214
EGG HARBOR TOWNSHIP NJ
08234-5549
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE BLDG 200 SUITE214
EGG HARBOR TOWNSHIP NJ
08234-5549
US

V. Phone/Fax

Practice location:
  • Phone: 609-677-7211
  • Fax: 609-677-7210
Mailing address:
  • Phone: 609-677-7211
  • Fax: 609-677-7210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number25ME00054701
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: