Provider Demographics
NPI:1578805198
Name:WHITE, WENDY W (RN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:W
Last Name:WHITE
Suffix:
Gender:F
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:PO BOX 718
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-0718
Mailing Address - Country:US
Mailing Address - Phone:803-321-2620
Mailing Address - Fax:803-321-1158
Practice Address - Street 1:1539 MARTIN ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2831
Practice Address - Country:US
Practice Address - Phone:803-321-2620
Practice Address - Fax:803-321-1158
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC62282163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool