Healthcare Provider Details

I. General information

NPI: 1124859871
Provider Name (Legal Business Name): LET IT GO JANET WHITE ADULT HEALTH NURSE PRACTITIONER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 E ROE BLVD
PATCHOGUE NY
11772-2611
US

IV. Provider business mailing address

30 HIGH PASTURE CIR
DIX HILLS NY
11746-5621
US

V. Phone/Fax

Practice location:
  • Phone: 631-408-1545
  • Fax:
Mailing address:
  • Phone: 917-324-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JANET WHITE
Title or Position: OWNER
Credential: DNP
Phone: 917-324-8860