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General NPI Number Information
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NPI Number | 1073274718
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Entity Type | Individual
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Provider Name | SARAH WHITE APN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/05/2022
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 104 E QUEENWOOD RD STE 202
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City | MORTON
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State | IL
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Zip | 61550-2962
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Country | US
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Telephone | 309-621-9580
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Fax |
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Provider Business Mailing Address
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Address Line | 116 S LOUISIANA AVE
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City | MORTON
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State | IL
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Zip | 61550-2638
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Country | US
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Telephone | 309-397-1397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 209021278
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License Number State | IL
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