Healthcare Provider Details

I. General information

NPI: 1700946845
Provider Name (Legal Business Name): NICOLE SUZANNE WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE S WHITE

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

IV. Provider business mailing address

4526 FEDERAL AVE
EVERETT WA
98203-2132
US

V. Phone/Fax

Practice location:
  • Phone: 425-349-6200
  • Fax: 425-349-8304
Mailing address:
  • Phone: 425-349-6200
  • Fax: 425-349-8304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number61668430
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC54505
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: