Provider Demographics
NPI:1508475906
Name:JESSICA M WHITE NURSING INC
Entity Type:Organization
Organization Name:JESSICA M WHITE NURSING INC
Other - Org Name:UNPC FAMILY MEDICINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:MS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-BC, ACNP-BC
Authorized Official - Phone:818-263-4362
Mailing Address - Street 1:2607 BRIDGEPORT WAY W STE 2E
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-4725
Mailing Address - Country:US
Mailing Address - Phone:253-948-9927
Mailing Address - Fax:
Practice Address - Street 1:2607 BRIDGEPORT WAY W STE 2E
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-4725
Practice Address - Country:US
Practice Address - Phone:253-948-9927
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2089002Medicaid