Healthcare Provider Details

I. General information

NPI: 1467175034
Provider Name (Legal Business Name): SHEENA MARIE WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W LANCASTER AVE
PAOLI PA
19301-1763
US

IV. Provider business mailing address

696 S FIVE POINTS RD
WEST CHESTER PA
19382-4607
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-1000
  • Fax:
Mailing address:
  • Phone: 610-504-7823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP026607
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: