MEDICARE: MRS. JANE LEE WHITE SFA

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1245936319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANE LEE WHITE SFA

Provider Business Mailing Address
First Line	:	19210 JAMES RIVER DR
Second Line	:
City	:	SPRING GROVE
State	:	VA
Zip	:	23881-9025
Country	:	US
Telephone Number	:	804-731-9516
Fax Number	:

Provider Business Practice Location Address
First Line	:	19210 JAMES RIVER DR
Second Line	:
City	:	SPRING GROVE
State	:	VA
Zip	:	23881-9025
Country	:	US
Telephone Number	:	804-731-9516
Fax Number	:

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

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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