MEDICARE: DONEISHIA LANETTE 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	374U00000X	Home Health Aide
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1720672942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONEISHIA LANETTE WHITE

Provider Business Mailing Address
First Line	:	2124 ROLLING CREEK RUN
Second Line	:
City	:	WHITE SETTLEMENT
State	:	TX
Zip	:	76108-4936
Country	:	US
Telephone Number	:	817-945-2210
Fax Number	:

Provider Business Practice Location Address
First Line	:	3632 STEWARD GARDENS WAY APT 2303
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76106-1509
Country	:	US
Telephone Number	:	817-893-3836
Fax Number	:

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

Provider Enumeration Date	:	02/28/2021
Last Update Date	:	02/28/2021

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Directions to “ DONEISHIA LANETTE WHITE ” Practice Location

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