Healthcare Provider Details

I. General information

NPI: 1043521933
Provider Name (Legal Business Name): JOHANNA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N OXFORD WALK 1E
BROOKLYN NY
11205-3167
US

IV. Provider business mailing address

151 N OXFORD WALK 1E
BROOKLYN NY
11205-3167
US

V. Phone/Fax

Practice location:
  • Phone: 917-450-3036
  • Fax:
Mailing address:
  • Phone: 917-450-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number437267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: