MEDICARE: LISA K WHITE CNP

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	08556-NP	OH

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	:	1477615730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA K WHITE CNP

Provider Business Mailing Address
First Line	:	2339 CHEVIOT HILLS LN
Second Line	:
City	:	VANDALIA
State	:	OH
Zip	:	45377-9688
Country	:	US
Telephone Number	:	937-603-9962
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 E GALBRAITH RD
Second Line	:	SUITE 302
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2754
Country	:	US
Telephone Number	:	888-393-9799
Fax Number	:	937-531-7789

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	07/05/2016

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