Provider Demographics
NPI:1710456082
Name:WHITE, SARAH DIANE (RN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:DIANE
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26138 HWY 25
Mailing Address - Street 2:APT B
Mailing Address - City:BELLE PLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:56011
Mailing Address - Country:US
Mailing Address - Phone:612-817-0697
Mailing Address - Fax:
Practice Address - Street 1:26138 HWY 25
Practice Address - Street 2:APT B
Practice Address - City:BELLE PLAINE
Practice Address - State:MN
Practice Address - Zip Code:56011
Practice Address - Country:US
Practice Address - Phone:612-817-0697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2458336163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse