Provider Demographics
NPI:1609573823
Name:WHITE, MICHELLE ROBERTA (APRN-CNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ROBERTA
Last Name:WHITE
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 ASHLAND AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383-1065
Mailing Address - Country:US
Mailing Address - Phone:636-456-0543
Mailing Address - Fax:636-456-1681
Practice Address - Street 1:511 ASHLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-1065
Practice Address - Country:US
Practice Address - Phone:636-456-0543
Practice Address - Fax:636-456-1681
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022004011363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics