Provider Demographics
NPI:1326705310
Name:WHITE, INDIA ELAINE
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:ELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-3354
Mailing Address - Country:US
Mailing Address - Phone:937-856-5344
Mailing Address - Fax:
Practice Address - Street 1:125 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-3354
Practice Address - Country:US
Practice Address - Phone:937-856-5344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver