Provider Demographics
NPI:1437865912
Name:WHITE, TAMMY L (MSN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:WHITE
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N FRYE ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62974-1128
Mailing Address - Country:US
Mailing Address - Phone:618-964-0081
Mailing Address - Fax:
Practice Address - Street 1:2401 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-1188
Practice Address - Country:US
Practice Address - Phone:618-997-5311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.276346163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator