MEDICARE: MRS. WANDA T WHITE CPC

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	101Y00000X	Counselor	CP5441	NV

General Provider Information

NPI Number	:	1750629945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA T WHITE CPC

Provider Business Mailing Address
First Line	:	10501 W GOWAN RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6602
Country	:	US
Telephone Number	:	702-530-2612
Fax Number	:	702-725-2526

Provider Business Practice Location Address
First Line	:	10501 W GOWAN RD STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6602
Country	:	US
Telephone Number	:	702-530-2612
Fax Number	:	702-725-2526

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

Provider Enumeration Date	:	01/22/2013
Last Update Date	:	11/27/2024

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