Provider Demographics
NPI:1891593505
Name:WHITE, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WHITE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 ROCKDELL DR APT 8
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2465
Mailing Address - Country:US
Mailing Address - Phone:326-216-1708
Mailing Address - Fax:937-591-2372
Practice Address - Street 1:2195 ROCKDELL DR APT 8
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2465
Practice Address - Country:US
Practice Address - Phone:326-216-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker