Provider Demographics
NPI:1598010357
Name:WHITE, CATHERINE ALICE (NP-C)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ALICE
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3448 COUNTY ROAD 41
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IN
Mailing Address - Zip Code:46793-9519
Mailing Address - Country:US
Mailing Address - Phone:260-402-8173
Mailing Address - Fax:260-927-8026
Practice Address - Street 1:2514 E DUPONT RD STE 100
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1619
Practice Address - Country:US
Practice Address - Phone:260-484-8830
Practice Address - Fax:260-266-2514
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2023-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28136952A363L00000X
IN71004058A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner