Provider Demographics
NPI:1306980024
Name:WHITE, MARY BETH (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARYBETH
Other - Middle Name:
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:280 EXEMPLA CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2203
Mailing Address - Country:US
Mailing Address - Phone:720-536-6644
Mailing Address - Fax:720-536-6630
Practice Address - Street 1:280 EXEMPLA CIR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3370
Practice Address - Country:US
Practice Address - Phone:720-536-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO58618163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO163W00000XOtherKAISER PERMANENTE