Provider Demographics
NPI:1619938297
Name:WHITE, ELIZABETH GROENDYKE (RNP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:GROENDYKE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28232 PASEO ANDANTE
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3334
Mailing Address - Country:US
Mailing Address - Phone:949-488-2873
Mailing Address - Fax:
Practice Address - Street 1:601 W 19TH ST
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5060
Practice Address - Country:US
Practice Address - Phone:949-548-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA366510363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health