Provider Demographics
NPI:1598567661
Name:WHITE, MARY L (RNC-NIC, BSN)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:WHITE
Suffix:
Gender:
Credentials:RNC-NIC, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 PINE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31705-5349
Mailing Address - Country:US
Mailing Address - Phone:229-376-6911
Mailing Address - Fax:
Practice Address - Street 1:406 PINE GLEN DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705-5349
Practice Address - Country:US
Practice Address - Phone:229-376-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN169539163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care