Provider Demographics
NPI:1619628112
Name:WHITE, CHRISTALE F (BSN RN)
Entity Type:Individual
Prefix:MS
First Name:CHRISTALE
Middle Name:F
Last Name:WHITE
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:MALKIA'S HERBS
Other - Middle Name:FOR LIFE
Other - Last Name:LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:382 ARCHIE JACOBS LN
Mailing Address - Street 2:
Mailing Address - City:CLARKTON
Mailing Address - State:NC
Mailing Address - Zip Code:28433-9537
Mailing Address - Country:US
Mailing Address - Phone:910-549-8265
Mailing Address - Fax:
Practice Address - Street 1:382 ARCHIE JACOBS LN
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-9537
Practice Address - Country:US
Practice Address - Phone:910-549-8265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-16
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 251J00000X
NC256227163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC256227OtherNC BOARD OF NURSING