MEDICARE: NICHOLE RENEE WHITE NP

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	363LF0000X	Family Nurse Practitioner	255867	AZ
2	363LF0000X	Family Nurse Practitioner	R210152	MD
3	363LF0000X	Family Nurse Practitioner	RN2264405	MA
4	163W00000X	Registered Nurse	2264405	MA

General Provider Information

NPI Number	:	1326342007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE RENEE WHITE NP

Provider Business Mailing Address
First Line	:	4390 MONTGOMERY RD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6068
Country	:	US
Telephone Number	:	410-203-1171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3536 W GLENDALE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85051-8395
Country	:	US
Telephone Number	:	480-618-0177
Fax Number	:	620-371-2243

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

Provider Enumeration Date	:	01/10/2011
Last Update Date	:	04/03/2026

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