Healthcare Provider Details

I. General information

NPI: 1619063757
Provider Name (Legal Business Name): MS. VALINDA JEANNE REDWING WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VALINDA JEANNE WHITE RD

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DRIVE
SISSETON SD
57262
US

IV. Provider business mailing address

100 LAKE TRAVERSE DRIVE WW KEEBLE MEMORIAL HEALTH CARE CENTER
SISSETON SD
57262-7046
US

V. Phone/Fax

Practice location:
  • Phone: 605-742-3631
  • Fax: 605-742-3896
Mailing address:
  • Phone: 605-742-3631
  • Fax: 605-742-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number0116
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: