Provider Demographics
NPI:1063533263
Name:WHITE, MARIE ANN (RN)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:MARIE
Other - Middle Name:ANN
Other - Last Name:DOUGENIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:74 SYLVESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-1553
Mailing Address - Country:US
Mailing Address - Phone:781-729-9266
Mailing Address - Fax:
Practice Address - Street 1:74 SYLVESTER AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-1553
Practice Address - Country:US
Practice Address - Phone:781-729-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0706426OtherMA HEALTH PROVIDER NUMBER