MEDICARE: AMANDA WHITE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	372500000X	Chore Provider
2	374700000X	Technician
3	3747A0650X	Attendant Care Provider
4	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1457713083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA WHITE

Provider Business Mailing Address
First Line	:	7511 LEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-2435
Country	:	US
Telephone Number	:	817-495-6567
Fax Number	:

Provider Business Practice Location Address
First Line	:	7511 LEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77028-2435
Country	:	US
Telephone Number	:	817-495-6567
Fax Number	:

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

Provider Enumeration Date	:	03/23/2016
Last Update Date	:	03/23/2016

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Directions to “ AMANDA WHITE ” Practice Location

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