Healthcare Provider Details

I. General information

NPI: 1770712622
Provider Name (Legal Business Name): DANA WHITE L.P.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

284 W LAKE ST
ROSEVILLE OH
43777-1120
US

IV. Provider business mailing address

284 W LAKE ST
ROSEVILLE OH
43777-1120
US

V. Phone/Fax

Practice location:
  • Phone: 740-588-3174
  • Fax:
Mailing address:
  • Phone: 740-214-5097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN.104480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: