Provider Demographics
NPI:1518335041
Name:WHITE, KORIN
Entity Type:Individual
Prefix:
First Name:KORIN
Middle Name:
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 1:48 HERON POINT RD
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:NH
Mailing Address - Zip Code:03809-5023
Mailing Address - Country:US
Mailing Address - Phone:603-859-3635
Mailing Address - Fax:
Practice Address - Street 1:48 HERON POINT RD
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:NH
Practice Address - Zip Code:03809-5023
Practice Address - Country:US
Practice Address - Phone:603-859-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
IL09613374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator