Provider Demographics
NPI:1093924532
Name:WHITE, ANDREA LEHONE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEHONE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:963 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14619-2346
Mailing Address - Country:US
Mailing Address - Phone:585-436-5994
Mailing Address - Fax:
Practice Address - Street 1:963 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14619-2346
Practice Address - Country:US
Practice Address - Phone:585-436-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239481-1374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01974276Medicaid