Provider Demographics
NPI:1912886334
Name:WHITE, CHANON DAWN
Entity type:Individual
Prefix:
First Name:CHANON
Middle Name:DAWN
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-0013
Mailing Address - Country:US
Mailing Address - Phone:614-515-1077
Mailing Address - Fax:
Practice Address - Street 1:8001 ASPEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-7039
Practice Address - Country:US
Practice Address - Phone:614-515-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker