Healthcare Provider Details

I. General information

NPI: 1306908678
Provider Name (Legal Business Name): DIANNA KAY WHITE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNA WHITE RN

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SO CO RD 1129
MIDLAND TX
79706-4853
US

IV. Provider business mailing address

1301 SO CO RD 1129
MIDLAND TX
79706-4853
US

V. Phone/Fax

Practice location:
  • Phone: 432-620-8515
  • Fax: 432-620-8515
Mailing address:
  • Phone: 432-620-8515
  • Fax: 432-620-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number633015
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: