Provider Demographics
NPI:1326713462
Name:WHITE, RHONDA LEE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:LEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FREDERICK ST
Mailing Address - Street 2:
Mailing Address - City:ILION
Mailing Address - State:NY
Mailing Address - Zip Code:13357-2541
Mailing Address - Country:US
Mailing Address - Phone:315-895-7471
Mailing Address - Fax:315-895-5255
Practice Address - Street 1:111 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:ILION
Practice Address - State:NY
Practice Address - Zip Code:13357-2541
Practice Address - Country:US
Practice Address - Phone:315-895-7471
Practice Address - Fax:315-895-5255
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY648756163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool