Provider Demographics
NPI:1457636250
Name:WHITE, ANGELA DIANA (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:DIANA
Last Name:WHITE
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59651 E 170 RD
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74343-2046
Mailing Address - Country:US
Mailing Address - Phone:918-452-3335
Mailing Address - Fax:918-452-3939
Practice Address - Street 1:59651 E 170 RD
Practice Address - Street 2:
Practice Address - City:FAIRLAND
Practice Address - State:OK
Practice Address - Zip Code:74343-2046
Practice Address - Country:US
Practice Address - Phone:918-452-3335
Practice Address - Fax:918-452-3939
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator