Provider Demographics
NPI:1477153633
Name:WHITE, KATREIA CHAREECE
Entity Type:Individual
Prefix:
First Name:KATREIA
Middle Name:CHAREECE
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 1:6800 ATWOOD ST APT 5
Mailing Address - Street 2:
Mailing Address - City:DISTRICT HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20747-1621
Mailing Address - Country:US
Mailing Address - Phone:202-714-1005
Mailing Address - Fax:
Practice Address - Street 1:5612 SAINT BARNABAS RD
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3626
Practice Address - Country:US
Practice Address - Phone:202-714-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management