Healthcare Provider Details

I. General information

NPI: 1285311514
Provider Name (Legal Business Name): AMY RAE WARNER-WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY RAE WHITE LPN

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 TRICORN RD
DANVILLE WV
25053-7148
US

IV. Provider business mailing address

PO BOX 148
BIM WV
25021-0148
US

V. Phone/Fax

Practice location:
  • Phone: 304-369-1385
  • Fax:
Mailing address:
  • Phone: 304-784-5589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number26862
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: