Provider Demographics
NPI:1194551549
Name:WHITE, LESSIE JONES (NURSING)
Entity type:Individual
Prefix:
First Name:LESSIE
Middle Name:JONES
Last Name:WHITE
Suffix:
Gender:F
Credentials:NURSING
Other - Prefix:
Other - First Name:LESSIE
Other - Middle Name:JONES
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NURSING
Mailing Address - Street 1:633 E RAY RD STE 130
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4206
Mailing Address - Country:US
Mailing Address - Phone:480-812-3680
Mailing Address - Fax:
Practice Address - Street 1:633 E RAY RD STE 130
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4206
Practice Address - Country:US
Practice Address - Phone:480-812-3680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002077807164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse