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General NPI Number Information
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NPI Number | 1619938297
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Entity Type | Individual
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Provider Name | ELIZABETH GROENDYKE WHITE RNP
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Gender | Female
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 601 W 19TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-5060
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Country | US
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Telephone | 949-548-8830
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Fax |
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Provider Business Mailing Address
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Address Line | 28232 PASEO ANDANTE
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675-3334
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Country | US
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Telephone | 949-488-2873
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 366510
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License Number State | CA
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