Provider Demographics
NPI:1659929529
Name:WHITE, MARVA ELAINE X
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:ELAINE
Last Name:WHITE
Suffix:X
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 1:9456 LAKE WOODS CT
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-4411
Mailing Address - Country:US
Mailing Address - Phone:251-401-1165
Mailing Address - Fax:
Practice Address - Street 1:9456 LAKE WOODS CT
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-4411
Practice Address - Country:US
Practice Address - Phone:251-401-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider