Provider Demographics
NPI:1396255592
Name:WHITE, JUANITA C
Entity type:Individual
Prefix:
First Name:JUANITA
Middle Name:C
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:PO BOX 876618
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-6618
Mailing Address - Country:US
Mailing Address - Phone:907-795-8250
Mailing Address - Fax:
Practice Address - Street 1:4001 E RUTH DR UNIT C
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7546
Practice Address - Country:US
Practice Address - Phone:907-795-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator