Provider Demographics
NPI:1386290773
Name:WHITE, NICHOLAS A (PMHNP-BC, MSN)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:WHITE
Suffix:
Gender:M
Credentials:PMHNP-BC, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3203 WILLAMETTE ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3348
Mailing Address - Country:US
Mailing Address - Phone:541-726-9912
Mailing Address - Fax:
Practice Address - Street 1:3203 WILLAMETTE ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3348
Practice Address - Country:US
Practice Address - Phone:541-726-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN212520163WP0808X
OR1386290773363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health