Provider Demographics
NPI:1558494716
Name:WHITE, DOUGLAS (CRNA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13698 COUNTY ROAD 126
Mailing Address - Street 2:
Mailing Address - City:PAULDING
Mailing Address - State:OH
Mailing Address - Zip Code:45879
Mailing Address - Country:US
Mailing Address - Phone:419-399-3162
Mailing Address - Fax:
Practice Address - Street 1:1065 DELAWARE AVE STE A
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6461
Practice Address - Country:US
Practice Address - Phone:740-387-7246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.00287-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered