Provider Demographics
NPI:1316433808
Name:WHITE, JUVEDIA TRACEY (LMECOS)
Entity type:Individual
Prefix:
First Name:JUVEDIA
Middle Name:TRACEY
Last Name:WHITE
Suffix:
Gender:F
Credentials:LMECOS
Other - Prefix:MS
Other - First Name:J.
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMECOS
Mailing Address - Street 1:8338 SHIELDS DR APT 203
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48609-8503
Mailing Address - Country:US
Mailing Address - Phone:989-392-4408
Mailing Address - Fax:
Practice Address - Street 1:3085 BAY RD STE 8
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-2405
Practice Address - Country:US
Practice Address - Phone:989-798-4374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment