Provider Demographics
NPI:1629637533
Name:WHITE, ZSAVONDA
Entity Type:Individual
Prefix:
First Name:ZSAVONDA
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 1:12138 BLUE RIDGE EXT
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1156
Mailing Address - Country:US
Mailing Address - Phone:816-763-3447
Mailing Address - Fax:573-475-8477
Practice Address - Street 1:12138 BLUE RIDGE EXT
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-1156
Practice Address - Country:US
Practice Address - Phone:816-763-3447
Practice Address - Fax:573-475-8477
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2020-12-08
Deactivation Date:2019-06-13
Deactivation Code:
Reactivation Date:2020-12-08
Provider Licenses
StateLicense IDTaxonomies
MO251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health