Provider Demographics
NPI:1275867871
Name:WHITE, IFETAYO JACQUELINE (BA, CMT, CBA)
Entity Type:Individual
Prefix:MS
First Name:IFETAYO
Middle Name:JACQUELINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:BA, CMT, CBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CORDGRASS LOOP
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29907-1714
Mailing Address - Country:US
Mailing Address - Phone:843-271-1923
Mailing Address - Fax:
Practice Address - Street 1:8 CORDGRASS LOOP
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29907-1714
Practice Address - Country:US
Practice Address - Phone:843-271-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-29
Last Update Date:2011-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula