=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235145558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA SUE ANN WHITE RN, CNS, -ACNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 09/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1300 N 4TH ST
-----------------------------------------------------
City | LONGVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75601-4717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-757-2122
-----------------------------------------------------
Fax | 903-757-9475
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 911230
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75391-1230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-997-8000
-----------------------------------------------------
Fax | 972-437-9605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 541465
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | AP106743
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------