Healthcare Provider Details

I. General information

NPI: 1003610957
Provider Name (Legal Business Name): DONNELLA CHANDELLE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 RUSTIC RD
DAYTON OH
45405-3237
US

IV. Provider business mailing address

2131 RUSTIC RD
DAYTON OH
45405-3237
US

V. Phone/Fax

Practice location:
  • Phone: 937-204-6066
  • Fax:
Mailing address:
  • Phone: 937-204-6066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: