MEDICARE: MRS. LORIE O 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	171WH0202X	Home Modifications Contractor	87198	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386807741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LORIE O WHITE

Provider Business Mailing Address
First Line	:	PO BOX 178
Second Line	:
City	:	FORDOCHE
State	:	LA
Zip	:	70732-0178
Country	:	US
Telephone Number	:	225-637-2178
Fax Number	:	225-637-2185

Provider Business Practice Location Address
First Line	:	5854 HIGHWAY 77
Second Line	:
City	:	FORDOCHE
State	:	LA
Zip	:	70732
Country	:	US
Telephone Number	:	225-637-2178
Fax Number	:	225-637-2185

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

Provider Enumeration Date	:	07/07/2008
Last Update Date	:	07/07/2008

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