Provider Demographics
NPI:1265034003
Name:WHITE, JEFFERY
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:
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 272
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:OH
Mailing Address - Zip Code:43528-0272
Mailing Address - Country:US
Mailing Address - Phone:419-277-0487
Mailing Address - Fax:419-865-3204
Practice Address - Street 1:1560 HOLLOWAY RD UNIT A
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:OH
Practice Address - Zip Code:43528-7509
Practice Address - Country:US
Practice Address - Phone:419-277-0487
Practice Address - Fax:419-865-3204
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide