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General NPI Number Information
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NPI Number | 1306197876
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Entity Type | Individual
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Provider Name | TINA WHITE
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Gender | Female
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 100 WASHINGTON ST
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City | FLORISSANT
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State | MO
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Zip | 63031-5921
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Country | US
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Telephone | 314-921-9498
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Fax | 314-921-9948
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Provider Business Mailing Address
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Address Line | 100 WASHINGTON ST.
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City | FLORISSANT
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State | MO
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Zip | 63031-1063
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Country | US
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Telephone | 314-921-9498
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Fax | 314-921-9948
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 2000149870
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number |
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License Number State |
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