Provider Demographics
NPI:1518928340
Name:WHITE, THOMAS R (CRNP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:WHITE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 E 13TH ST STE 1300
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1035
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:PA
Practice Address - Zip Code:16438-1068
Practice Address - Country:US
Practice Address - Phone:814-438-7208
Practice Address - Fax:814-438-8062
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP005750B363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner