Provider Demographics
NPI:1235145558
Name:WHITE, MONICA SUE ANN (RN, CNS, -ACNP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:SUE ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN, CNS, -ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1300 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4717
Practice Address - Country:US
Practice Address - Phone:903-757-2122
Practice Address - Fax:903-757-9475
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541465363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181161402Medicaid
TX181161401Medicaid
TXP01752671OtherRAILROAD
TXP01752671OtherRAILROAD
TX8G7378Medicare PIN
TX181161402Medicaid