MEDICARE: MRS. LYNDA GAYLE WHITE RN

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	163WS0200X	School Registered Nurse	R46650	NM

General Provider Information

NPI Number	:	1740795962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYNDA GAYLE WHITE RN

Provider Business Mailing Address
First Line	:	PO BOX 5
Second Line	:
City	:	SAN JON
State	:	NM
Zip	:	88434-0005
Country	:	US
Telephone Number	:	575-576-2466
Fax Number	:

Provider Business Practice Location Address
First Line	:	7TH AND ELM
Second Line	:
City	:	SAN JON
State	:	NM
Zip	:	88434
Country	:	US
Telephone Number	:	575-576-2466
Fax Number	:

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

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	03/17/2018

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