Provider Demographics
NPI:1568818078
Name:WHITE, THERESA (DO)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1528 TEMPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3012
Mailing Address - Country:US
Mailing Address - Phone:440-382-2646
Mailing Address - Fax:
Practice Address - Street 1:810 SIXTH AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-5396
Practice Address - Country:US
Practice Address - Phone:208-265-2242
Practice Address - Fax:208-265-8214
Is Sole Proprietor?:No
Enumeration Date:2016-05-13
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDO-1713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program