Healthcare Provider Details

I. General information

NPI: 1215447420
Provider Name (Legal Business Name): CATHY MCNEILL WHITE NNP, B-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

1160 POINT VIEW RD
CHAPIN SC
29036-7923
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-2912
  • Fax: 803-434-4309
Mailing address:
  • Phone: 803-361-6620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number654
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: