Provider Demographics
NPI:1669817623
Name:WHITE, LILLIAN MICHELLE (ARNP)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:MICHELLE
Other - Last Name:CONMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:906 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2554
Mailing Address - Country:US
Mailing Address - Phone:619-435-9505
Mailing Address - Fax:
Practice Address - Street 1:31 NE STATE ROUTE 300 STE 200
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-05
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60839109363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1669817623Medicaid