Provider Demographics
NPI:1093792285
Name:WHITE, BETTY J (ARNP)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:J
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:BETTY
Other - Middle Name:J
Other - Last Name:CRAIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2202 S CEDAR ST
Mailing Address - Street 2:STE 330
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2318
Mailing Address - Country:US
Mailing Address - Phone:253-503-2508
Mailing Address - Fax:
Practice Address - Street 1:1519 3RD ST SE STE 230
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372
Practice Address - Country:US
Practice Address - Phone:253-841-8640
Practice Address - Fax:583-841-7645
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00115014363LA2200X
WAAP30006706363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1002270Medicaid
WA9641051Medicaid
WAP00671959Medicare PIN
WAG8851596Medicare PIN
WAG8851597Medicare PIN
WA8851594Medicare PIN
WA8868187Medicare PIN
WA8868423Medicare PIN
WAG8880511Medicare PIN
WA001045700Medicare PIN
WA000188100Medicare PIN
WAAP30006706OtherWA LICENSE
WAG8851594Medicare PIN