MEDICARE: KATHERINE GRACE 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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1245062959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE GRACE WHITE

Provider Business Mailing Address
First Line	:	1 EAGLE RD
Second Line	:
City	:	ALAMEDA
State	:	CA
Zip	:	94501-5100
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 YERBA BUENA RD
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94130-1527
Country	:	US
Telephone Number	:	541-404-2777
Fax Number	:

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

Provider Enumeration Date	:	08/20/2024
Last Update Date	:	08/20/2024

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Directions to “ KATHERINE GRACE WHITE ” Practice Location

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