Provider Demographics
NPI:1558661405
Name:WHITE, NATHIA STEPHANIE
Entity Type:Individual
Prefix:
First Name:NATHIA
Middle Name:STEPHANIE
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 1:35 MARION ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-6219
Mailing Address - Country:US
Mailing Address - Phone:857-222-7529
Mailing Address - Fax:781-874-0945
Practice Address - Street 1:35 MARION ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6219
Practice Address - Country:US
Practice Address - Phone:857-222-7529
Practice Address - Fax:781-874-0945
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide