Provider Demographics
NPI:1609654151
Name:WHITE, PERSIA
Entity Type:Individual
Prefix:
First Name:PERSIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 LIBERTY LOOP APT 204
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBRG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-9630
Mailing Address - Country:US
Mailing Address - Phone:571-991-6707
Mailing Address - Fax:
Practice Address - Street 1:2029 LIBERTY LOOP APT 204
Practice Address - Street 2:
Practice Address - City:FREDERICKSBRG
Practice Address - State:VA
Practice Address - Zip Code:22408-9630
Practice Address - Country:US
Practice Address - Phone:571-991-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1409811376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty