Provider Demographics
NPI:1174653000
Name:WHITE, LINDA SUZANNE (SA-C)
Entity Type:Individual
Prefix:MISS
First Name:LINDA
Middle Name:SUZANNE
Last Name:WHITE
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14843 MANCHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANA
Mailing Address - State:TN
Mailing Address - Zip Code:37037-5817
Mailing Address - Country:US
Mailing Address - Phone:931-394-3910
Mailing Address - Fax:
Practice Address - Street 1:14843 MANCHESTER PIKE
Practice Address - Street 2:
Practice Address - City:CHRISTIANA
Practice Address - State:TN
Practice Address - Zip Code:37037-5817
Practice Address - Country:US
Practice Address - Phone:931-394-3910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA129246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist