Healthcare Provider Details

I. General information

NPI: 1043714850
Provider Name (Legal Business Name): ANNE LYNN WHITE NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date: 05/15/2018
Reactivation Date: 06/21/2018

III. Provider practice location address

1100 VOLVO PKWY STE 100
CHESAPEAKE VA
23320-3341
US

IV. Provider business mailing address

860 OMNI BLVD STE 101
NEWPORT NEWS VA
23606-4430
US

V. Phone/Fax

Practice location:
  • Phone: 757-389-5370
  • Fax:
Mailing address:
  • Phone: 757-232-8769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: