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NPI Code Detail

MEDICARE: MRS. ELIZABETH GROENDYKE WHITE RNP

MEDICARE: MRS. ELIZABETH GROENDYKE WHITE RNP
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
1363LW0102XWomen's Health Nurse Practitioner366510CA

General Provider Information

NPI Number : 1619938297
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH GROENDYKE WHITE RNP
Provider Business Mailing Address
First Line : 28232 PASEO ANDANTE
Second Line :
City : SAN JUAN CAPISTRANO
State : CA
Zip : 92675-3334
Country : US
Telephone Number : 949-488-2873
Fax Number :
Provider Business Practice Location Address
First Line : 601 W 19TH ST
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-5060
Country : US
Telephone Number : 949-548-8830
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2006
Last Update Date : 12/20/2011

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