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NPI Code Detail

MEDICARE: DIANE MARIE WHITE RN NP-C

MEDICARE: DIANE MARIE WHITE RN NP-C
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
1363LF0000XFamily Nurse Practitioner0024114870VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10024114870OTHERVACOMMONWEALTH OF VIRGINIA LISCENSE TO PRACTICE AS NP
20017001008OTHERVACOMMONWEALTH OF VIRGINIA AUTHORIZATION TO PRESCRIBE LIC NP
30001114870OTHERVACOMMONWEALTH OF VIRGINIA LISCENSE TO PRACTICE AS RN

General Provider Information

NPI Number : 1194081885
Entity Type Code : Individual
Provider Name (Legal Business Name) : DIANE MARIE WHITE RN NP-C
Provider Business Mailing Address
First Line : 2807 N GLEBE RD
Second Line : MARYMOUNT UNIVERSITY STUDENT HEALTH CENTER
City : ARLINGTON
State : VA
Zip : 22207-4224
Country : US
Telephone Number : 703-284-1610
Fax Number : 703-284-3816
Provider Business Practice Location Address
First Line : 2807 N GLEBE RD
Second Line : MARYMOUNT UNIVERSITY STUDENT HEALTH CENTER
City : ARLINGTON
State : VA
Zip : 22207-4224
Country : US
Telephone Number : 703-284-1610
Fax Number : 703-284-3816
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2012
Last Update Date : 04/06/2012

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