Provider Demographics
NPI:1093964744
Name:WHITE, MICHELE LYNN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:LYNN
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:LYNN
Other - Last Name:FORRESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7780 S BROADWAY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2648
Mailing Address - Country:US
Mailing Address - Phone:303-734-8650
Mailing Address - Fax:303-734-8653
Practice Address - Street 1:7780 S BROADWAY
Practice Address - Street 2:SUITE 350
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2648
Practice Address - Country:US
Practice Address - Phone:303-734-8650
Practice Address - Fax:303-734-8653
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69479163W00000X
CONP 5783363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO73434256Medicaid
COCO304697Medicare PIN
CO73434256Medicaid