Provider Demographics
NPI:1558825190
Name:WHITE, CALLIE CAROLEA (ARNP)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:CAROLEA
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:CAROLEA
Other - Last Name:TESTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ANSGAR
Mailing Address - State:IA
Mailing Address - Zip Code:50472-1352
Mailing Address - Country:US
Mailing Address - Phone:641-736-4401
Mailing Address - Fax:
Practice Address - Street 1:140 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ANSGAR
Practice Address - State:IA
Practice Address - Zip Code:50472-1352
Practice Address - Country:US
Practice Address - Phone:641-736-4401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA119391363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care