Provider Demographics
NPI:1497508337
Name:WHITE, HEATHER (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-1605
Mailing Address - Country:US
Mailing Address - Phone:207-454-2000
Mailing Address - Fax:
Practice Address - Street 1:53 GARFIELD ST
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1605
Practice Address - Country:US
Practice Address - Phone:207-454-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN44959163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool