MEDICARE: MS. MICHELLE ROBERTA WHITE APRN-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	363LP0200X	Pediatric Nurse Practitioner	2022004011	MO

General Provider Information

NPI Number	:	1609573823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE ROBERTA WHITE APRN-CNP

Provider Business Mailing Address
First Line	:	511 ASHLAND AVE STE A
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-1065
Country	:	US
Telephone Number	:	636-456-0543
Fax Number	:	636-456-1681

Provider Business Practice Location Address
First Line	:	511 ASHLAND AVE STE A
Second Line	:
City	:	WARRENTON
State	:	MO
Zip	:	63383-1065
Country	:	US
Telephone Number	:	636-456-0543
Fax Number	:	636-456-1681

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

Provider Enumeration Date	:	02/08/2023
Last Update Date	:	02/08/2023

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