Provider Demographics
NPI:1285311514
Name:WARNER-WHITE, AMY RAE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RAE
Last Name:WARNER-WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RAE
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:BIM
Mailing Address - State:WV
Mailing Address - Zip Code:25021-0148
Mailing Address - Country:US
Mailing Address - Phone:304-784-5589
Mailing Address - Fax:
Practice Address - Street 1:298 TRICORN RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25053-7148
Practice Address - Country:US
Practice Address - Phone:304-369-1385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse