Provider Demographics
NPI:1699167528
Name:WHITE, NANCY (RN,IBCLC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN,IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 MCGRAW ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-6054
Mailing Address - Country:US
Mailing Address - Phone:858-361-2760
Mailing Address - Fax:
Practice Address - Street 1:3315 MCGRAW ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6054
Practice Address - Country:US
Practice Address - Phone:858-361-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710629163WL0100X
CA11225762163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant