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General NPI Number Information
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NPI Number | 1376883918
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Entity Type | Individual
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Provider Name | DOUGLAS N. WHITE PNP
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Gender | Male
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Dates
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Enumeration Date | 02/19/2013
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Last Update Date | 08/09/2019
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Provider Practice Location Address
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Address Line | 1215 LEE ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-2824
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Country | US
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Telephone | 434-924-1761
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Fax | 434-982-3561
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Provider Business Mailing Address
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Address Line | PO BOX 9007
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22906-9007
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Country | US
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Telephone |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 0024171765
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License Number State | VA
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