MEDICARE: MS. ELAINE M 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	363LA2200X	Adult Health Nurse Practitioner	338051	CA

General Provider Information

NPI Number	:	1588669378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE M WHITE NP

Provider Business Mailing Address
First Line	:	2130 STOCKTON BLVD
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95817-1337
Country	:	US
Telephone Number	:	916-875-0701
Fax Number	:	916-876-5615

Provider Business Practice Location Address
First Line	:	4600 BROADWAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-1527
Country	:	US
Telephone Number	:	916-874-9670
Fax Number	:

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	04/19/2011

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