Provider Demographics
NPI:1043755390
Name:WHITE, LEA C (LICAC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:LICAC
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:WHITE
Other - Last Name:ROBISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8629
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-8629
Mailing Address - Country:US
Mailing Address - Phone:541-550-0847
Mailing Address - Fax:
Practice Address - Street 1:1554 NE 4TH STREET
Practice Address - Street 2:MIDTOWN WELLNESS CENTER
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701
Practice Address - Country:US
Practice Address - Phone:541-550-0847
Practice Address - Fax:541-209-5570
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-22
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201675171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist