Provider Demographics
NPI:1205727179
Name:WHITE, LEA (RN)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEA
Other - Middle Name:
Other - Last Name:DUCLOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:617 COMSTOCK RD STE 5
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:VT
Mailing Address - Zip Code:05602-8498
Mailing Address - Country:US
Mailing Address - Phone:802-223-2003
Mailing Address - Fax:802-223-2235
Practice Address - Street 1:617 COMSTOCK RD STE 5
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:VT
Practice Address - Zip Code:05602-8498
Practice Address - Country:US
Practice Address - Phone:802-223-2003
Practice Address - Fax:802-223-2235
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-10
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0137728163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Single Specialty