MEDICARE: QUEENIE WHITE

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	163W00000X	Registered Nurse	527296	NY
2	163WC1500X	Community Health Registered Nurse	527296	NY
3	163WD0400X	Diabetes Educator Registered Nurse	527296	NY
4	163WH0200X	Home Health Registered Nurse	527296	NY
5	163WI0500X	Infusion Therapy Registered Nurse	527296	NY
6	163WM0102X	Maternal Newborn Registered Nurse	527296	NY
7	163WM0705X	Medical-Surgical Registered Nurse	527296	NY
8	163WP2201X	Ambulatory Care Registered Nurse	527296	NY
9	163WW0000X	Wound Care Registered Nurse	527296	NY
10	163WX0002X	High-Risk Obstetric Registered Nurse	527296	NY
11	163WX0106X	Occupational Health Registered Nurse	527296	NY

General Provider Information

NPI Number	:	1669847869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	QUEENIE WHITE

Provider Business Mailing Address
First Line	:	2440 HUNTER AVE
Second Line	:	APARTMENT 26E
City	:	BRONX
State	:	NY
Zip	:	10475-5646
Country	:	US
Telephone Number	:	718-666-5954
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 HUNTER AVE
Second Line	:	APARTMENT 26E
City	:	BRONX
State	:	NY
Zip	:	10475-5646
Country	:	US
Telephone Number	:	718-666-5954
Fax Number	:

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

Provider Enumeration Date	:	12/14/2015
Last Update Date	:	12/14/2015

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Directions to “ QUEENIE WHITE ” Practice Location

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