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NPI Code Detail

MEDICARE: ELIZABETH J WHITE RNFA

MEDICARE: ELIZABETH J WHITE RNFA
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
1163W00000XRegistered Nurse653526TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10008KEOTHERTXBLUE CROSS

General Provider Information

NPI Number : 1407963895
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH J WHITE RNFA
Provider Business Mailing Address
First Line : PO BOX 11219
Second Line :
City : FORT WORTH
State : TX
Zip : 76110-0219
Country : US
Telephone Number : 817-294-7444
Fax Number :
Provider Business Practice Location Address
First Line : 11801 SOUTH FWY
Second Line :
City : BURLESON
State : TX
Zip : 76028-7021
Country : US
Telephone Number : 817-293-9110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 07/08/2007

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