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General NPI Number Information
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NPI Number | 1124445895
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Entity Type | Individual
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Provider Name | JENNA WHITE
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Gender | Female
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Dates
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Enumeration Date | 03/19/2014
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 26433 CR GG
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City | ROCKY FORD
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State | CO
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Zip | 81067-8106
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Country | US
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Telephone | 719-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 E 3RD ST
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City | LA JUNTA
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State | CO
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Zip | 81050-1906
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Country | US
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Telephone | 719-363-1514
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Fax | 719-468-2427
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0991101
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License Number State | CO
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