Provider Demographics
NPI:1518492677
Name:WHITE, KORI
Entity Type:Individual
Prefix:
First Name:KORI
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 1:30800 NORTHWESTERN HWY STE 223
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2550
Mailing Address - Country:US
Mailing Address - Phone:248-662-8081
Mailing Address - Fax:
Practice Address - Street 1:2484 GLYNN CT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48206-1747
Practice Address - Country:US
Practice Address - Phone:248-662-8081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No374U00000XNursing Service Related ProvidersHome Health Aide