Healthcare Provider Details

I. General information

NPI: 1972747079
Provider Name (Legal Business Name): REBECCA WHITE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2009
Last Update Date: 01/29/2020
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 ELECTRIC RD STE 1030
SALEM VA
24153-7474
US

IV. Provider business mailing address

2900 LAMB CIR STE 202
CHRISTIANSBURG VA
24073-6480
US

V. Phone/Fax

Practice location:
  • Phone: 540-774-6000
  • Fax:
Mailing address:
  • Phone: 540-731-4578
  • Fax: 540-731-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72820
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024169966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: