Provider Demographics
NPI:1194034637
Name:WHITE, LISA PEARL (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:PEARL
Last Name:WHITE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COLISEUM DR STE 280
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5974
Mailing Address - Country:US
Mailing Address - Phone:757-827-2455
Mailing Address - Fax:757-452-5773
Practice Address - Street 1:4000 COLISEUM DR STE 280
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5974
Practice Address - Country:US
Practice Address - Phone:757-827-2455
Practice Address - Fax:757-452-5773
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678313367A00000X
VA0024185913367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife