Provider Demographics
NPI:1558004234
Name:WHITE, TAQUAN M
Entity Type:Individual
Prefix:
First Name:TAQUAN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 K ST NE APT 908
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-8226
Mailing Address - Country:US
Mailing Address - Phone:120-281-7385
Mailing Address - Fax:202-817-3854
Practice Address - Street 1:250 K ST NE APT 908
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-8226
Practice Address - Country:US
Practice Address - Phone:120-281-7385
Practice Address - Fax:202-817-3854
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant