Provider Demographics
NPI:1417200668
Name:WHITE, CYNTHIA ELAINE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:ELAINE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4919 W GOLDEN LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-5020
Mailing Address - Country:US
Mailing Address - Phone:602-595-2308
Mailing Address - Fax:602-595-2308
Practice Address - Street 1:1100 N 35TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5210
Practice Address - Country:US
Practice Address - Phone:602-381-4665
Practice Address - Fax:602-381-4662
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program