Provider Demographics
NPI:1558967547
Name:WHITE, COURTNEY ROSE (LVN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROSE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:R
Other - Last Name:BEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6717 COSTA DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-6677
Mailing Address - Country:US
Mailing Address - Phone:951-419-1732
Mailing Address - Fax:
Practice Address - Street 1:6717 COSTA DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6677
Practice Address - Country:US
Practice Address - Phone:951-419-1732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350160164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse