Provider Demographics
NPI:1033298666
Name:WHITE, LINDA NELL (CRNA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:NELL
Last Name:WHITE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 1411
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1411
Mailing Address - Country:US
Mailing Address - Phone:956-245-8603
Mailing Address - Fax:
Practice Address - Street 1:751 LUCKENBACH CAIN-CITY RD.
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-7862
Practice Address - Country:US
Practice Address - Phone:956-245-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX518582174400000X
TX054588367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX156434611OtherCSHCN
TX156434610Medicaid
TX88869UOtherBLUE CROSS/BLUE SHIELD
TX156434610Medicaid