Provider Demographics
NPI:1376759928
Name:WHITE, ELIZABETH M (ANP-BC, GNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:ANP-BC, GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4508 CHESTNUT ST
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-3608
Mailing Address - Country:US
Mailing Address - Phone:215-573-3632
Mailing Address - Fax:215-573-6848
Practice Address - Street 1:ONE PENN PLAZA
Practice Address - Street 2:8TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:917-282-9554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304620-1363LA2200X
NYF340723-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology