=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326602301
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELANIE J N WHITE FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2019
-----------------------------------------------------
Last Update Date | 04/08/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 717 MEADE ST STE 100
-----------------------------------------------------
City | RAPID CITY
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57701-5100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-864-4919
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 STARDUST TRL
-----------------------------------------------------
City | TUSCOLA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79562-3689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-428-6953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 30076
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------