Provider Demographics
NPI:1689279853
Name:WHITE, SHIRLEY RAYE
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:RAYE
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 1:190 LUTHER JONES RD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH JUNCTION
Mailing Address - State:WV
Mailing Address - Zip Code:25442-4754
Mailing Address - Country:US
Mailing Address - Phone:304-279-0939
Mailing Address - Fax:
Practice Address - Street 1:190 LUTHER JONES RD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH JUNCTION
Practice Address - State:WV
Practice Address - Zip Code:25442-4754
Practice Address - Country:US
Practice Address - Phone:304-279-0939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant