Provider Demographics
NPI:1639595473
Name:WHITE, COLDELIA (BHRS)
Entity Type:Individual
Prefix:
First Name:COLDELIA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 NE BRIARCLIFF CIR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-2306
Mailing Address - Country:US
Mailing Address - Phone:580-357-8114
Mailing Address - Fax:580-699-3567
Practice Address - Street 1:1202 SW A AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3821
Practice Address - Country:US
Practice Address - Phone:580-357-8114
Practice Address - Fax:580-699-3567
Is Sole Proprietor?:No
Enumeration Date:2014-03-17
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator