Provider Demographics
NPI:1740795962
Name:WHITE, LYNDA GAYLE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LYNDA
Middle Name:GAYLE
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:PO BOX 5
Mailing Address - Street 2:
Mailing Address - City:SAN JON
Mailing Address - State:NM
Mailing Address - Zip Code:88434-0005
Mailing Address - Country:US
Mailing Address - Phone:575-576-2466
Mailing Address - Fax:
Practice Address - Street 1:7TH AND ELM
Practice Address - Street 2:
Practice Address - City:SAN JON
Practice Address - State:NM
Practice Address - Zip Code:88434
Practice Address - Country:US
Practice Address - Phone:575-576-2466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR46650163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool