Provider Demographics
NPI:1306476833
Name:WHITE, THELMA LOUISE
Entity type:Individual
Prefix:MRS
First Name:THELMA
Middle Name:LOUISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 LIONS ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-4347
Mailing Address - Country:US
Mailing Address - Phone:573-931-3730
Mailing Address - Fax:573-471-5314
Practice Address - Street 1:124 N WEST ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2332
Practice Address - Country:US
Practice Address - Phone:573-931-3730
Practice Address - Fax:573-471-5314
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)