Provider Demographics
NPI:1477150647
Name:WHITE, QUIENNE (MT)
Entity Type:Individual
Prefix:
First Name:QUIENNE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 ROY CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-8199
Mailing Address - Country:US
Mailing Address - Phone:732-667-0646
Mailing Address - Fax:
Practice Address - Street 1:3150 RTE 22 STE 6
Practice Address - Street 2:
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3595
Practice Address - Country:US
Practice Address - Phone:908-704-0404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00690600225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist