Provider Demographics
NPI:1437485182
Name:WHITE, CHRISTOPHER WILLIAM (ACNP-BC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WILLIAM
Last Name:WHITE
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:WILLIAM
Other - Last Name:DONALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:500 ENTERPRISE DR STE 4A
Mailing Address - Street 2:EVERCARE/OPTUM
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3913
Mailing Address - Country:US
Mailing Address - Phone:203-887-5682
Mailing Address - Fax:
Practice Address - Street 1:114 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3008
Practice Address - Country:US
Practice Address - Phone:203-887-5682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004229363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400044363Medicaid
CTD400063711Medicaid