Provider Demographics
NPI:1992976617
Name:WHITE, CHARLOTTE L (ARNP, MN, CNS)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP, MN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N PORTER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67204-2509
Mailing Address - Country:US
Mailing Address - Phone:316-259-7171
Mailing Address - Fax:316-838-3657
Practice Address - Street 1:5300 N PORTER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67204-2509
Practice Address - Country:US
Practice Address - Phone:316-259-7171
Practice Address - Fax:316-838-3657
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74675363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner