Healthcare Provider Details

I. General information

NPI: 1174882674
Provider Name (Legal Business Name): CHICQUITA WHITE WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2012
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 YALE DR
HAMPTON VA
23666-3721
US

IV. Provider business mailing address

468 RIVERS RIDGE CIR
NEWPORT NEWS VA
23608-1069
US

V. Phone/Fax

Practice location:
  • Phone: 757-826-2079
  • Fax: 757-825-9165
Mailing address:
  • Phone: 757-888-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024169749
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: