Provider Demographics
NPI:1336545466
Name:WHITE, NANCY (CRNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 NATIONAL HWY
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7618
Mailing Address - Country:US
Mailing Address - Phone:240-362-0288
Mailing Address - Fax:240-362-0052
Practice Address - Street 1:1313 NATIONAL HWY
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-7618
Practice Address - Country:US
Practice Address - Phone:240-362-0288
Practice Address - Fax:240-362-0052
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF0914840363LF0000X
MDR106652363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD087423000Medicaid
MD387021ZB9FMedicare PIN