MEDICARE: JANE WHITE NP

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	363L00000X	Nurse Practitioner	0024-082828	VA

General Provider Information

NPI Number	:	1588636401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE WHITE NP

Provider Business Mailing Address
First Line	:	5741 RAN LYNN DR
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-5421
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3707 BRAMBLETON AVE
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3658
Country	:	US
Telephone Number	:	540-725-7800
Fax Number	:

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	05/23/2008

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