Provider Demographics
NPI:1306848312
Name:WHITE-LINN, VIRGINIA MARY (NP-C)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARY
Last Name:WHITE-LINN
Suffix:
Gender:F
Credentials:NP-C
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 994
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-0994
Mailing Address - Country:US
Mailing Address - Phone:989-466-7188
Mailing Address - Fax:989-463-0663
Practice Address - Street 1:2480 ROSEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-3823
Practice Address - Fax:989-773-5061
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI470411172363L00000X
MI4704111172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114911084Medicaid
MI1020579OtherMCLAREN HEALTH PLAN
MI5008706520OtherBCBSM PIN
MIP577686Medicare UPIN
MIP00349773Medicare PIN
MI114911084Medicaid