Provider Demographics
NPI:1538641311
Name:WHITE, AVRIELLE (NP)
Entity Type:Individual
Prefix:
First Name:AVRIELLE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 6TH ST APT 5E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3497
Mailing Address - Country:US
Mailing Address - Phone:917-890-2991
Mailing Address - Fax:
Practice Address - Street 1:39 W 14TH ST STE 506
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7403
Practice Address - Country:US
Practice Address - Phone:929-777-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2021-06-24
Deactivation Date:2019-04-05
Deactivation Code:
Reactivation Date:2019-06-14
Provider Licenses
StateLicense IDTaxonomies
NY402686363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health