Provider Demographics
NPI:1548936842
Name:WHITE, STEPHANIE RAE (RD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2034
Mailing Address - Country:US
Mailing Address - Phone:210-775-1600
Mailing Address - Fax:
Practice Address - Street 1:1305 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2034
Practice Address - Country:US
Practice Address - Phone:210-775-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered