Provider Demographics
NPI:1497051072
Name:WHITE, RENE MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1638
Mailing Address - Country:US
Mailing Address - Phone:910-728-9332
Mailing Address - Fax:
Practice Address - Street 1:512 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-4306
Practice Address - Country:US
Practice Address - Phone:978-427-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH067538-23363LF0000X
NC198768363LF0000X
MARN278406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily