Provider Demographics
NPI:1659961357
Name:WHITE, CORY ANDREW (RN, BSN)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:ANDREW
Last Name:WHITE
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 MANOR DR STE 10
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4917
Mailing Address - Country:US
Mailing Address - Phone:814-472-6060
Mailing Address - Fax:814-472-1293
Practice Address - Street 1:429 MANOR DR STE 10
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4917
Practice Address - Country:US
Practice Address - Phone:814-472-6060
Practice Address - Fax:814-472-1293
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN710577163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse