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General NPI Number Information
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NPI Number | 1114869070
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Entity Type | Individual
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Provider Name | JENNA LEEANN WHITE LAT, ATC, MS
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Gender | Female
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Dates
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Enumeration Date | 04/08/2026
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Last Update Date | 04/08/2026
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Provider Practice Location Address
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Address Line | 3111 10TH ST
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City | MARION
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State | IA
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Zip | 52302-5434
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Country | US
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Telephone | 319-447-3106
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Fax |
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Provider Business Mailing Address
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Address Line | 1620 RANMAR DR
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City | ELY
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State | IA
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Zip | 52227-9557
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Country | US
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Telephone | 319-389-6449
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 132965
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License Number State | IA
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