Provider Demographics
NPI:1033987706
Name:WHITE, EMMA LOREE (CNM)
Entity Type:Individual
Prefix:MISS
First Name:EMMA
Middle Name:LOREE
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:EMMA
Other - Middle Name:LOREE
Other - Last Name:PROVOST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1950 W FRYE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6255
Mailing Address - Country:US
Mailing Address - Phone:480-895-9555
Mailing Address - Fax:
Practice Address - Street 1:1950 W FRYE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6255
Practice Address - Country:US
Practice Address - Phone:480-895-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCNM301120367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife