MEDICARE: ALONZO M 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	163WC0400X	Case Management Registered Nurse	R084793	AR

General Provider Information

NPI Number	:	1104477959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALONZO M WHITE

Provider Business Mailing Address
First Line	:	1717 LOUISIANA ST APT R
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-1402
Country	:	US
Telephone Number	:	501-319-5614
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 LOUISIANA ST APT R
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72206-1402
Country	:	US
Telephone Number	:	501-319-5614
Fax Number	:

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

Provider Enumeration Date	:	09/24/2019
Last Update Date	:	09/24/2019

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