Provider Demographics
NPI:1417438144
Name:WHITE, JADAARIANA MONAE
Entity Type:Individual
Prefix:
First Name:JADAARIANA
Middle Name:MONAE
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 1:3260 FOUNTAIN FALLS WAY APT 2020
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89032-2225
Mailing Address - Country:US
Mailing Address - Phone:909-671-6136
Mailing Address - Fax:
Practice Address - Street 1:3260 FOUNTAIN FALLS WAY APT 2020
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-2225
Practice Address - Country:US
Practice Address - Phone:909-671-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician