Provider Demographics
NPI:1114655883
Name:WHITE, LAUSHA MARIE (REGISTER NURSE)
Entity Type:Individual
Prefix:
First Name:LAUSHA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:REGISTER NURSE
Other - Prefix:
Other - First Name:LAUSHA
Other - Middle Name:MARIE
Other - Last Name:JEFFERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:88 BRADY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT GIBSON
Mailing Address - State:MS
Mailing Address - Zip Code:39150-2806
Mailing Address - Country:US
Mailing Address - Phone:601-618-4115
Mailing Address - Fax:
Practice Address - Street 1:88 BRADY AVE
Practice Address - Street 2:
Practice Address - City:PORT GIBSON
Practice Address - State:MS
Practice Address - Zip Code:39150-2806
Practice Address - Country:US
Practice Address - Phone:601-618-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS900891163W00000X
MS906396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty