Provider Demographics
NPI:1184666380
Name:WHITE, LINDA LOUISE (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LOUISE
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LOUISE
Other - Last Name:BISCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1061 S BEACON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2588
Mailing Address - Country:US
Mailing Address - Phone:616-846-2015
Mailing Address - Fax:616-846-7227
Practice Address - Street 1:1061 S BEACON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2588
Practice Address - Country:US
Practice Address - Phone:616-846-2015
Practice Address - Fax:616-846-7227
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704137552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4840456Medicaid
MI4840456Medicaid
MIQ65117Medicare UPIN