Provider Demographics
NPI:1629260674
Name:WHITE, MARY KAY
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
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 1:415 LOCHMOOR PL
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2053
Mailing Address - Country:US
Mailing Address - Phone:541-343-8322
Mailing Address - Fax:541-343-3318
Practice Address - Street 1:415 LOCHMOOR PL
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2053
Practice Address - Country:US
Practice Address - Phone:541-343-8322
Practice Address - Fax:541-343-3318
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse