Provider Demographics
NPI:1669847869
Name:WHITE, QUEENIE
Entity Type:Individual
Prefix:
First Name:QUEENIE
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 1:2440 HUNTER AVE
Mailing Address - Street 2:APARTMENT 26E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5646
Mailing Address - Country:US
Mailing Address - Phone:718-666-5954
Mailing Address - Fax:
Practice Address - Street 1:2440 HUNTER AVE
Practice Address - Street 2:APARTMENT 26E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5646
Practice Address - Country:US
Practice Address - Phone:718-666-5954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY527296163W00000X, 163WC1500X, 163WD0400X, 163WH0200X, 163WI0500X, 163WM0102X, 163WM0705X, 163WP2201X, 163WW0000X, 163WX0002X, 163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163WX0106XNursing Service ProvidersRegistered NurseOccupational Health