MEDICARE: DR. IASHA WHITE NMD

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	175F00000X	Naturopath	17-1690	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0	OTHER		NOT COVERED

General Provider Information

NPI Number	:	1639686017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IASHA WHITE NMD

Provider Business Mailing Address
First Line	:	4621 S 8TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2229
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4621 S 8TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85040-2229
Country	:	US
Telephone Number	:	602-326-7286
Fax Number	:

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

Provider Enumeration Date	:	01/06/2018
Last Update Date	:	01/06/2018

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