=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184116808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL WHITE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2018
-----------------------------------------------------
Last Update Date | 05/30/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3268 SHELTON STORE RD
-----------------------------------------------------
City | BUCKINGHAM
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23921-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-969-4008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3268 SHELTON STORE RD
-----------------------------------------------------
City | BUCKINGHAM
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23921-2440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-969-4008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------