Provider Demographics
NPI:1962926402
Name:WHITE, ANGELLA LEONIE (RN,CDE)
Entity type:Individual
Prefix:
First Name:ANGELLA
Middle Name:LEONIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN,CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-2108
Mailing Address - Country:US
Mailing Address - Phone:951-258-0272
Mailing Address - Fax:
Practice Address - Street 1:8805 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-2108
Practice Address - Country:US
Practice Address - Phone:951-258-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA760036163WD0400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator