Provider Demographics
NPI:1013588037
Name:WHITE, TEARANI LATERA
Entity Type:Individual
Prefix:
First Name:TEARANI
Middle Name:LATERA
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 1:37659 LITTLE MACK AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2367
Mailing Address - Country:US
Mailing Address - Phone:586-930-2943
Mailing Address - Fax:
Practice Address - Street 1:37659 LITTLE MACK AVE APT 302
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2367
Practice Address - Country:US
Practice Address - Phone:586-930-2943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist