Provider Demographics
NPI:1073700639
Name:WHITE, ELIZA (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 MANTUA PIKE
Mailing Address - Street 2:601 OFFICE PLAZA - 2ND FLOOR
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1141
Mailing Address - Country:US
Mailing Address - Phone:856-468-8330
Mailing Address - Fax:856-468-9121
Practice Address - Street 1:1050 MANTUA PIKE
Practice Address - Street 2:601 OFFICE PLAZA - 2ND FLOOR
Practice Address - City:WENONAH
Practice Address - State:NJ
Practice Address - Zip Code:08090-1141
Practice Address - Country:US
Practice Address - Phone:856-468-8330
Practice Address - Fax:856-468-9121
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN08747700363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics