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General NPI Number Information
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NPI Number | 1245544683
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Entity Type | Individual
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Provider Name | NENNA J WHITE RMT
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Gender | Female
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Dates
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Enumeration Date | 07/27/2010
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Last Update Date | 07/27/2010
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Provider Practice Location Address
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Address Line | 602 COLORADO AVE
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City | LA JUNTA
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State | CO
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Zip | 81050-2310
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Country | US
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Telephone | 719-383-0296
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 LINCOLN AVE APT 17
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City | LA JUNTA
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State | CO
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Zip | 81050-3284
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Country | US
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Telephone | 719-691-0143
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2821
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License Number State | CO
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