Provider Demographics
NPI:1710910641
Name:WHITE, SHERREN M (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:SHERREN
Middle Name:M
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 S CREYTS RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8290
Mailing Address - Country:US
Mailing Address - Phone:517-886-0333
Mailing Address - Fax:517-886-2072
Practice Address - Street 1:416 S CREYTS RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8290
Practice Address - Country:US
Practice Address - Phone:517-886-0333
Practice Address - Fax:517-886-2072
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N71020Medicare ID - Type Unspecified