MEDICARE: NICOLE 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	225200000X	Physical Therapy Assistant	160.005685	IL
2	163WH0200X	Home Health Registered Nurse	041.480844	IL

General Provider Information

NPI Number	:	1841631694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE WHITE

Provider Business Mailing Address
First Line	:	2035 S STATE ST UNIT 16042
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-8201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2035 S STATE ST UNIT 16042
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-8201
Country	:	US
Telephone Number	:	312-871-1811
Fax Number	:

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

Provider Enumeration Date	:	07/09/2013
Last Update Date	:	07/26/2024

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Directions to “ NICOLE WHITE ” Practice Location

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