MEDICARE: MRS. SHIRLEY H. WHITE CRNA

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	367500000X	Certified Registered Nurse Anesthetist	NA 1168	CA

General Provider Information

NPI Number	:	1023007994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY H. WHITE CRNA

Provider Business Mailing Address
First Line	:	4059 MOUNTAIN RANCH RD
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9429
Country	:	US
Telephone Number	:	209-754-9167
Fax Number	:	209-729-5734

Provider Business Practice Location Address
First Line	:	768 MOUNTAIN RANCH RD
Second Line	:
City	:	SAN ANDREAS
State	:	CA
Zip	:	95249-9707
Country	:	US
Telephone Number	:	209-754-2523
Fax Number	:

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	07/08/2007

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