MEDICARE: MRS. KATRINA WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1013761477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATRINA WHITE

Provider Business Mailing Address
First Line	:	1200 GROESBECK RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-3280
Country	:	US
Telephone Number	:	312-608-7282
Fax Number	:

Provider Business Practice Location Address
First Line	:	7879 GREENLAND PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-1005
Country	:	US
Telephone Number	:	513-882-6239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2024
Last Update Date	:	04/28/2024

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Directions to “ MRS. KATRINA WHITE ” Practice Location

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