Provider Demographics
NPI:1417096124
Name:WHITE, BARBARA ANN (MSN, APRN, BC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANN
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 PINEY WOODS PL
Mailing Address - Street 2:D104
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-5980
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 C ST
Practice Address - Street 2:SUITE G
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4152
Practice Address - Country:US
Practice Address - Phone:301-617-2767
Practice Address - Fax:301-617-3971
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR136830363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP02714Medicare UPIN