Provider Demographics
NPI:1568849917
Name:RODRIGUEZ WHITE, STEPHEN A (RN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:RODRIGUEZ WHITE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17872 TYLER DR NW
Mailing Address - Street 2:
Mailing Address - City:ELK RIVER
Mailing Address - State:MN
Mailing Address - Zip Code:55330-4720
Mailing Address - Country:US
Mailing Address - Phone:612-760-2624
Mailing Address - Fax:
Practice Address - Street 1:17872 TYLER DR NW
Practice Address - Street 2:
Practice Address - City:ELK RIVER
Practice Address - State:MN
Practice Address - Zip Code:55330-4720
Practice Address - Country:US
Practice Address - Phone:612-760-2624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR192997-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse