Provider Demographics
NPI:1235830126
Name:WHITE, DESSIRAE (RN)
Entity Type:Individual
Prefix:
First Name:DESSIRAE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 30TH RD
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:KS
Mailing Address - Zip Code:67491-9341
Mailing Address - Country:US
Mailing Address - Phone:620-245-5190
Mailing Address - Fax:
Practice Address - Street 1:1625 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1226
Practice Address - Country:US
Practice Address - Phone:620-728-0923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-111356-081163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse