MEDICARE: KIONA J 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1376273839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIONA J WHITE

Provider Business Mailing Address
First Line	:	3215 GLENWOOD AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43610-1020
Country	:	US
Telephone Number	:	419-324-6712
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 MELROSE AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43610-1523
Country	:	US
Telephone Number	:	419-266-2903
Fax Number	:

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

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	06/15/2022

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