Provider Demographics
NPI:1306855952
Name:WHITE, DESIREE E (ARNP)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:E
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 100TH ST SW STE 510
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2767
Mailing Address - Country:US
Mailing Address - Phone:253-459-6060
Mailing Address - Fax:
Practice Address - Street 1:5700 100TH ST SW STE 510
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2767
Practice Address - Country:US
Practice Address - Phone:253-459-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00920037OtherRAILROAD MEDICARE
P00920037OtherRAILROAD MEDICARE
WA9642471Medicare ID - Type Unspecified
WA8809173Medicare ID - Type Unspecified